Cystic duct carcinoma: a proposal for a new "working definition".
BACKGROUND
Farrar's criteria for cystic duct carcinoma (histopathological diagnosis of a carcinoma strictly limited to the cystic duct) have practical limitations. We propose new "working definition": a gallbladder tumor, the center of which is located in the cystic duct.


METHODS
Between 1980 and 2000 we diagnosed cystic duct carcinoma in 31 patients, 28 of whom (90%) had increased serum bilirubin concentrations. Extrahepatic bile duct resection and cholecystectomy were performed in 10 patients; in others, extended right hepatectomy (16), right hepatectomy (3), and liver bed resection (2) were necessary as well for a potentially curative resection. Additional procedures were portal vein resection (10) and pancreatoduodenectomy (7).


RESULTS
All tumors were adenocarcinomas. Depth of invasion was T2 in 3 patients, T3 in 12, and T4 in 16. Thirteen patients (42%) had lymph node metastasis. Curative resection was performed in 24 patients (77%). Hospital mortality was 5 of 31 (16%). Actuarial 5-year survival rate excluding hospital deaths was 22%.


CONCLUSIONS
The proposed "working definition" avoids the problems associated with Farrar's criteria and describes a distinct patient group with an approximately equal proportion of men and women, advanced T stage, but a lower than expected frequency of lymph node metastasis. It establishes a basis for standard reporting of results.
Ozden
Ilgin
I
Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumaicho Showaku, Nagoya 466-8550, Japan.
Kamiya
Junichi
J
Nagino
Masato
M
Uesaka
Katsuhiko
K
Oda
Koji
K
Sano
Tsuyoshi
T
Kamiya
Satoshi
S
Nimura
Yuji
Y
D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D001652:Bile Ducts / Q000473:pathology* / Q000601:surgery; D001707:Biopsy, Needle; D002758:Cholangiography; D002763:Cholecystectomy / Q000379:methods; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005260:Female; D005706:Gallbladder Neoplasms / Q000473:pathology* / Q000601:surgery; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D009626:Terminology as Topic; D016896:Treatment Outcome