title: Papillary carcinoma of the extrahepatic bile duct: characteristic features and implications in surgical treatment.
abstract: BACKGROUND
  Papillary carcinoma of the extrahepatic bile duct presents clinically and histologically distinct features relevant to surgical decision-making.
  
  
  METHODS
  Serial sections of 15 specimens of resected papillary carcinoma of the bile duct were histologically examined to determine mode of spread, possibility of multicentric tumor origins, and coincidence with other neoplastic lesions. The presence of anomalous pancreaticobiliary ductal union was also investigated. These characteristics were considered with regard to surgical treatment.
  
  
  RESULTS
  Three patients displaying pancreaticobiliary maljunction and one of three patients with a long common channel (> or = 8 mm) exhibited multicentric tumors. Eight patients (53%) demonstrated superficial spread along a mean length of 37.8 mm (range, 5 to 67 mm) of bile duct mucosa. Multicentric tumors developed synchronously in 4 patients, while metachronous tumors were identified in three patients displaying tumor histology similar to the primary lesions. Two of these three underwent successful repeated resection. Concomitant neoplastic lesions in the biliary tract were identified as mucosal dysplasia in four patients and cholangiocellular carcinoma of the liver in two. All tumors but one were removed via hepatic lobectomy or pancreatoduodenectomy, or both, resulting in a 5-year survival rate of 60%.
  
  
  CONCLUSIONS
  Aggressive resection offers clear survival benefits for patients presenting with tumors displaying extensive superficial spread or multicentric origins. Closer attention should be paid to long common channels in relation to carcinogenesis of the bile duct, in addition to pancreaticobiliary maljunction. The risk of secondary tumor development remains, particularly in patients with pancreaticobiliary maljunction even after excision of the tumor-bearing extrahepatic bile duct.
authors.affiliation: Department of Surgery, Tokyo Metropolitan Komagome Hospital, Japan.
authors.forename: Atsutake
authors.initials: A
authors.lastname: Okamoto
authors.forename: Koji
authors.initials: K
authors.lastname: Tsuruta
authors.forename: Gaku
authors.initials: G
authors.lastname: Matsumoto
authors.forename: Toshio
authors.initials: T
authors.lastname: Takahashi
authors.forename: Terumi
authors.initials: T
authors.lastname: Kamisawa
authors.forename: Naoto
authors.initials: N
authors.lastname: Egawa
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Funata
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000473:pathology* / Q000601:surgery*; D002291:Carcinoma, Papillary / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000473:pathology / Q000601:surgery; D016609:Neoplasms, Second Primary / Q000473:pathology / Q000601:surgery; D012086:Reoperation; D016019:Survival Analysis; D016896:Treatment Outcome