title: Significance of ductal margin status in patients undergoing surgical resection for extrahepatic cholangiocarcinoma.
abstract: OBJECTIVE
  The objective of this study was to determine whether carcinoma in situ at the bile duct margin is prognostically different from residual invasive carcinoma in patients with extrahepatic cholangiocarcinoma. Although there are many reports that the ductal margin status at bile duct resection stumps is a prognostic indicator in patients with extrahepatic cholangiocarcinoma, some patients who undergo resection with microscopic tumor involvement of the bile duct margin survive longer than expected.
  
  
  METHODS
  A retrospective clinicopathological analysis of 128 patients who had undergone surgical resection for extrahepatic cholangiocarcinoma was conducted. The status of the bile duct resection margin was classified as negative in 105 patients (82.0%), positive for carcinoma in situ in 12 patients (9.4%), and positive for invasive carcinoma in 11 patients (8.6%).
  
  
  RESULTS
  Ductal margin status was an independent prognostic indicator by both univariate (p = 0.0022) and multivariate (p = 0.0105) analyses, along with lymph node metastasis. There was no significant difference between patients with a negative ductal margin and those with a positive ductal margin with carcinoma in situ (p = 0.5247). The 5-year survival rate of patients with a positive ductal margin with carcinoma in situ (22.2%) was significantly better (p = 0.0241) than with invasive carcinoma (0%). There was a significant relationship between local recurrence and ductal margin status (p = 0.0401).
  
  
  CONCLUSIONS
  Among patients undergoing surgical resection for extrahepatic cholangiocarcinoma, invasive carcinoma at the ductal resection margins appears to have a significant relation to local recurrence and also a significant negative impact on survival, whereas residual carcinoma in situ does not. Discrimination whether carcinoma in situ or invasive carcinoma is present is important in clinical setting in which the resection margin at the ductal stump is positive.
authors.affiliation: Department of Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan. rsasaki@md.tsukuba.ac.jp.|Department of Surgery, Iwate Medical University School of Medicine, Morioka, Japan. rsasaki@md.tsukuba.ac.jp.
authors.forename: Ryoko
authors.initials: R
authors.lastname: Sasaki
authors.affiliation: Department of Surgery, Iwate Medical University School of Medicine, Morioka, Japan.|Division of Pathology, Department of Central Clinical Laboratory, Iwate Medical University School of Medicine, Morioka, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Takeda
authors.affiliation: Department of Surgery, Iwate Medical University School of Medicine, Morioka, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Funato
authors.affiliation: Department of Surgery, Iwate Medical University School of Medicine, Morioka, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nitta
authors.affiliation: Department of Surgery, Iwate Medical University School of Medicine, Morioka, Japan.
authors.forename: Hidenobu
authors.initials: H
authors.lastname: Kawamura
authors.affiliation: Division of Pathology, Department of Central Clinical Laboratory, Iwate Medical University School of Medicine, Morioka, Japan.
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Uesugi
authors.affiliation: Division of Pathology, Department of Central Clinical Laboratory, Iwate Medical University School of Medicine, Morioka, Japan.
authors.forename: Tamotsu
authors.initials: T
authors.lastname: Sugai
authors.affiliation: Department of Surgery, Iwate Medical University School of Medicine, Morioka, Japan.
authors.forename: Go
authors.initials: G
authors.lastname: Wakabayashi
authors.affiliation: Department of Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Ohkohchi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017734:Bile Ducts, Extrahepatic / Q000473:pathology* / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000379:methods* / Q000401:mortality; D002278:Carcinoma in Situ / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis