title: Impact of residual in situ carcinoma on postoperative survival in 125 patients with extrahepatic bile duct carcinoma.
abstract: OBJECTIVE
  The aim of this study was to determine the impact of the presence of carcinoma in situ at the bile duct stump on postoperative survival in patients who underwent resection of extrahepatic bile duct carcinoma.
  
  
  METHODS
  The patients with resected extrahepatic bile duct carcinoma were divided into three groups according to resected margin status: no evidence of residual carcinoma (Negative group, n = 96); carcinoma in situ at the bile duct stump (CIS group, n = 10); and invasive carcinoma at any surgical margin (Invasive group, n = 19). Cause-specific survival for these groups was compared statistically.
  
  
  RESULTS
  Surgical margin status was identified as a prognostic factor on univariate analysis (p = 0.005) and was an independent prognostic factor on multivariate analysis (p = 0.018). The CIS group displayed significantly better survival than the Invasive group (p = 0.006), and the survival was comparable to that for the Negative group (p = 0.533). Two of three patients in the CIS group with local recurrence died >5 years after surgical resection.
  
  
  CONCLUSIONS
  Patients with positive ductal margins of carcinoma in situ of the extrahepatic bile duct do not appear to show different survival after resection compared to patients with negative margins, but remnant carcinoma in situ is likely to develop late local recurrence.
authors.affiliation: Department of Surgical Oncology, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan. y.nakanishi@mac.com
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Nakanishi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kondo
authors.forename: Yoh
authors.initials: Y
authors.lastname: Zen
authors.forename: Atsuya
authors.initials: A
authors.lastname: Yonemori
authors.forename: Kanako
authors.initials: K
authors.lastname: Kubota
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawakami
authors.forename: Eiichi
authors.initials: E
authors.lastname: Tanaka
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hirano
authors.forename: Tomoo
authors.initials: T
authors.lastname: Itoh
authors.forename: Yasuni
authors.initials: Y
authors.lastname: Nakanuma
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D017734:Bile Ducts, Extrahepatic; D002278:Carcinoma in Situ / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D018365:Neoplasm, Residual / Q000401:mortality* / Q000473:pathology; D011184:Postoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends