Prediction of Distal Ductal Margin Status Using the Distance Between the Posterior Superior Pancreaticoduodenal Artery and the Tumor in Surgery for Perihilar Cholangiocarcinoma.

Abstract

Ductal margin status affects survival in patients with resected perihilar cholangiocarcinoma (PHC). However, accurate prediction of distal ductal margin (DM) status remains challenging. We aimed to assess the predictive performance of the distance between the posterior superior pancreaticoduodenal artery (PSPDA) and the tumor for assessing the DM status in surgery for PHC. In this retrospective review of consecutive PHC patients who underwent major hepatectomy between May 2010 and May 2023, the PSPDA-to-tumor distance was measured using coronal multidetector-row computed tomography images, and the cut-off value of this distance for predicting the DM status was determined. Patient, surgical, and pathological characteristics and operative curability were compared relative to the PSPDA-to-tumor distance. Univariate and multivariate analyses were performed to identify predictors of DM status. The distance between the PSPDA and tumor was measured in 157/162 (97%) patients. Of these, 23 (15%) were DM positive and 134 (85%) were DM negative. The distance between the PSPDA and tumor was shorter in the DM-positive than the DM-negative group (5.6 ± 1.6 mm vs. 19.5 ± 1.1 mm, p < 0.001). The cut-off value of the distance for DM status was determined as 9.0 mm. On multivariate analysis, PSPDA-to-tumor distance of < 9.0 mm was found to be independently associated with DM positivity in surgery for PHC (odds ratio: 72.8, 95% confidence interval: 9.0-585.5). The distance between the PSPDA and tumor might be useful for predicting the DM status at surgery for PHC.