BACKGROUND AND PURPOSE This study aimed to determine the prognostic factors and generate an atlas of a distribution of locoregional recurrence (LRR) in patients with distal cholangiocarcinoma (DCCA), after pancreatoduodenectomy (PD) without adjuvant radiotherapy. MATERIALS AND METHODS 124 DCCA cases registered in our institutional database from 2006 to 2018 were analyzed retrospectively. The Cox proportional hazards model was used for multivariable analysis. All recurrence sites were centrally reviewed, and LRRs were plotted on one CT scan of a template that represents the relapse pattern of the patients. RESULTS The median follow-up time was 35.3 months (95% CI 22.1-48.5 months). Independent prognostic factor for locoregional recurrence-free survival was lymph node metastasis (p = 0.014). Older age, pancreas invasion, and lymph node metastasis were associated with poor survival (both p < 0.05). During the follow-up period, 69 patients (55.6%) developed disease progression. Among them, 45 patients (65.2%) had recurrence in the locoregional components. 21 patients (30.4%) were diagnosed with liver metastasis. Of the patients with LRR, most recurrences occurred in the nodes along the superior mesenteric artery (36.2%), nodes around the abdominal aorta (26.1%), nodes in the hepatoduodenal ligament (13.0%), nodes around the celiac artery (10.1%), and anastomotic stoma (10.1%). CONCLUSION The high-risk sites of LRR after PD for primary DCCA are the nodes along the superior mesenteric artery, abdominal aorta, nodes in the hepatoduodenal ligament, nodes around the celiac artery, and anastomotic stoma. Adjuvant radiation should cover these areas to improve locoregional control for these patients.

中文翻译：

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远端胆管癌根治性切除术后的预后因素和复发模式

背景和目的 本研究旨在确定预后因素并生成远端胆管癌 (DCCA) 患者在未进行辅助放疗的胰十二指肠切除术 (PD) 后局部复发 (LRR) 分布图谱。材料与方法 回顾性分析了 2006 年至 2018 年在我们机构数据库中登记的 124 例 DCCA 病例。Cox比例风险模型用于多变量分析。集中审查所有复发部位，并将 LRR 绘制在代表患者复发模式的模板的一次 CT 扫描上。结果 中位随访时间为 35.3 个月（95% CI 22.1-48.5 个月）。局部无复发生存的独立预后因素是淋巴结转移（p = 0.014）。年纪大了，胰脏受侵，和淋巴结转移与较差的存活率相关（均 p < 0.05）。在随访期间，69 名患者 (55.6%) 出现疾病进展。其中，45 例（65.2%）患者局部复发。21例（30.4%）被诊断为肝转移。LRR患者中，大部分复发发生在肠系膜上动脉沿淋巴结（36.2%）、腹主动脉周围淋巴结（26.1%）、肝十二指肠韧带淋巴结（13.0%）、腹腔动脉周围淋巴结（10.1%） ) 和吻合口 (10.1%)。结论原发性DCCA PD后LRR的高危部位为肠系膜上动脉沿淋巴结、腹主动脉、肝十二指肠韧带淋巴结、腹腔动脉周围淋巴结和吻合口。