Significance of ductal margin status in patients undergoing surgical resection for extrahepatic cholangiocarcinoma.
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.
Sasaki
Ryoko
R
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.
Takeda
Yuichiro
Y
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.
Funato
Osamu
O
Department of Surgery, Iwate Medical University School of Medicine, Morioka, Japan.
Nitta
Hiroyuki
H
Department of Surgery, Iwate Medical University School of Medicine, Morioka, Japan.
Kawamura
Hidenobu
H
Department of Surgery, Iwate Medical University School of Medicine, Morioka, Japan.
Uesugi
Noriyuki
N
Division of Pathology, Department of Central Clinical Laboratory, Iwate Medical University School of Medicine, Morioka, Japan.
Sugai
Tamotsu
T
Division of Pathology, Department of Central Clinical Laboratory, Iwate Medical University School of Medicine, Morioka, Japan.
Wakabayashi
Go
G
Department of Surgery, Iwate Medical University School of Medicine, Morioka, Japan.
Ohkohchi
Nobuhiro
N
Department of Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan.
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