title: Evaluation of portal vein invasion of distal cholangiocarcinoma as borderline resectability.
abstract: BACKGROUND
  The concept of borderline resectability has not yet been introduced for extrahepatic cholangiocarcinoma (ECC). In this study, the surgical results of ECC patients were analyzed to clarify the implications of surgery for distal ECC with portal vein (PV) invasion as a preliminary step for the introduction of the concept of borderline resectability.
  
  
  METHODS
  The clinicopathological data of 129 patients who had undergone pancreatoduodenectomy of distal ECC were reviewed retrospectively. Combined PV resection was performed in 10 patients. The clinicopathological variables were evaluated using univariate and multivariate analyses.
  
  
  RESULTS
  Pathological PV invasion was observed in eight of the 129 patients. The survival rates of patients with PV invasion were significantly poorer than those of patients without PV invasion: 3 and 5 years after surgery, 17% and 0% versus 50% and 39% (P < 0.001), respectively. Presence of pancreatic or PV invasion, tumor progression, nodal status, and residual tumor were significant prognostic factors on univariate analysis. On multivariate analysis, PV invasion was the only significant independent predictive factor of a poor prognosis.
  
  
  CONCLUSIONS
  PV invasion of distal ECC should be regarded as indicating borderline resectability.
authors.affiliation: Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan. f-miura@med.teikyo-u.ac.jp.
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Miura
authors.forename: Keiji
authors.initials: K
authors.lastname: Sano
authors.forename: Hodaka
authors.initials: H
authors.lastname: Amano
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Toyota
authors.forename: Keita
authors.initials: K
authors.lastname: Wada
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yoshida
authors.forename: Koichi
authors.initials: K
authors.lastname: Hayano
authors.forename: Hisahiro
authors.initials: H
authors.lastname: Matsubara
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Takada
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D009361:Neoplasm Invasiveness; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011169:Portal Vein; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
keywords: Borderline respectability; Distal cholangiocarcinoma; Portal vein invasion; Prognostic factor