Clinical relevance of the red blood cell distribution width measured preoperatively as a prognostic marker in patients with distal cholangiocarcinoma undergoing pancreaticoduodenectomy

Maiko Niki; Shozo Mori; Shotaro Miyashita; Tomoaki Hayakawa; Genki Tanaka; Takayuki Shimizu; Takamune Yamaguchi; Kyung-Hwa Park; Takayuki Shiraki; Takatsugu Matsumoto; Taku Aoki

doi:10.1007/s00595-025-03005-1

Clinical relevance of the red blood cell distribution width measured preoperatively as a prognostic marker in patients with distal cholangiocarcinoma undergoing pancreaticoduodenectomy

Surg Today. 2025 Mar 29. doi: 10.1007/s00595-025-03005-1. Online ahead of print.

Affiliations

¹ Department of Hepato-Biliary-Pancreatic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan.
² Department of Hepato-Biliary-Pancreatic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan. s-mori@dokkyomed.ac.jp.

PMID: 40156628
DOI: 10.1007/s00595-025-03005-1

Abstract

Purpose: The clinical relevance of the red blood cell distribution width (RDW) in patients with distal cholangiocarcinoma (DCC) undergoing pancreaticoduodenectomy (PD) has not been clearly investigated.

Methods: The relationship between the preoperatively measured RDW and prognosis for the recurrence/survival was evaluated in patients with DCC undergoing PD. A subgroup analysis was also performed in patients with pathological stage I DCC.

Results: A total of 77 patients were included in the analysis. The cutoff value of the preoperatively measured RDW was set at 14%, and the normal reference range at our center was ≤ 14%. The patient group with an RDW > 14% (n = 30) had a significantly lower mean serum albumin level, higher mean serum carbohydrate antigen 19-9 level, and a higher proportion of cases with pathological lymphatic invasion and showed a significantly worse overall survival than the patient group with an RDW ≤ 14% (n = 47). Similar findings were noted in both the overall study population and patients with pathological stage I disease. Multivariate analysis identified an RDW > 14% and pathological lymph node metastasis as independent risk factors for a poor postoperative survival.

Conclusion: The preoperatively measured RDW is a promising prognostic predictor in patients with DCC undergoing PD.

Keywords: Cholangiocarcinoma; Lymph node metastasis; Pancreaticoduodenectomy; Prognostic marker; Red blood cell distribution width.