Clinicopathological difference between invasive pancreatic duct cancer and distal bile duct cancer of the pancreas head after pancreaticoduodenectomy

Aims: The only curative treatment for patients with invasive pancreatic duct cancer (IPDC) and distal bile duct cancer (DBDC) of the pancreas head is pancreaticoduodenectomy (PD). However, the clinicopathological difference between IPDC and DBDC after PD has not been thoroughly discussed. In this study, we retrospectively analyzed the clinical and pathological difference between IPDC and DBDC in patients who underwent PD. Methods: Sixty-six patients who underwent curative PD were enrolled (IPDC, n = 35; DBDC, n = 31). Preoperative, intraoperative, and postoperative parameters and pathological factors (stages, lymph node metastasis, lymphatic invasion, vascular invasion, and perineural invasion) were compared. Results: Jaundice was frequently detected and preoperative biliary drainage was frequently performed in patients with DBDC (60.5% and 90.3%, respectively). Additionally, the preoperative serum total bilirubin concentration and C-reactive protein/albumin ratio were higher in patients with DBDC than IPDC. As a result, the occurrence of postoperative pancreatic fistula occurred more frequently in patients with DBDC. In contrast, lymph node metastasis, lymphatic invasion, and vascular invasion were detected more frequently in patients with IPDC. The overall 5-year survival rate of the 35 patients with IPDC (13.4%) was much worse than that of the 31 patients with DBDC (52.3%, p less than 0.001). Conclusion: The oncological characteristics of IPDC are much different from those of DBDC. More effective treatment should be started in patients with IPDC as soon as possible.