Top

Published in:

01-09-2007

Significance of Ductal Margin Status in Patients Undergoing Surgical Resection for Extrahepatic Cholangiocarcinoma

Authors: Ryoko Sasaki, Yuichiro Takeda, Osamu Funato, Hiroyuki Nitta, Hidenobu Kawamura, Noriyuki Uesugi, Tamotsu Sugai, Go Wakabayashi, Nobuhiro Ohkohchi

Published in: World Journal of Surgery | Issue 9/2007

Abstract

Objectives

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.

Summary Background Data

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 classifiedas 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.

Nagorney DM, Donohue JH, Farnell MB, et al. (1993) Outcomes after curative resections of cholangiocarcinoma. Arch Surg 128:871–879PubMed

Fong Y, Blumgart LH, Lin E, et al. (1996) Outcome of treatment for distal bile duct cancer. Br J Surg 83:1712–1715PubMedCrossRef

Chamberlain RS, Blumgart LH. (2000) Hilar cholangiocarcinoma: a review and commentary. Ann Surg Oncol 7:55–66PubMedCrossRef

Ahrendt SA, Cameron JL, Pitt HA. (1997) Current management of patients with perihilar cholangiocarcinoma. Adv Surg 30:427–452

Jarnagin WR, Shoup M. (2004) Surgical management of cholangiocarcinoma. Semin Liver Dis 24:189–199PubMedCrossRef

Klempnauer J, Ridder GJ, Werner M, et al. (1997) What constitutes long-term survival after surgery for hilar cholangiocarcinoma? Cancer 79:26–34PubMedCrossRef

Hemming AW, Reed AI, Fujita S, et al. (2005) Surgical management of hilar cholangiocarcinoma. Ann Surg 241:693–702PubMedCrossRef

Bosma A. (1990) Surgical pathology of cholangiocarcinoma of the liver hilus (Klatskin tumor). Semin Liver Dis 10:85–90PubMedCrossRef

Nakeeb A, Pit HA, Sohn TA, et al. (1996) Cholangiocarcinoma. A spectrum of intrahepatic, perihilar, and distal tumors. Ann Surg 224:463–473PubMedCrossRef

10.

Kawasaki S, Imamura H, Kobayashi A, et al. (2003) Results of surgical resection for patients with hilar bile duct cancer: application of extended hepatectomy after biliary drainage and hemihepatic portal vein embolization. Ann Surg 238:84–92PubMedCrossRef

11.

Jang JY, Kim SW, Park DJ, et al. (2005) Actual long-term outcome of extrahepatic bile duct cancer after surgical resection. Ann Surg 241:77–84PubMed

12.

Sakamoto Y, Kosuge T, Shimada K, et al. (2005) Prognostic factors of surgical resection in middle and distal bile duct cancer: an analysis of 55 patients concerning the significance of ductal and radial margins. Surgery 137:396–402PubMedCrossRef

13.

Bismuth H, Nakache R, Diamond T. (1992) Management strategies in resection for hilar cholangiocarcinoma. Ann Surg 215:31–38PubMedCrossRef

14.

Bismuth H, Corlette MB. (1975) Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver. Surg Gynecol Obstet 140:170–178PubMed

15.

Greene FL, Page DL, Fleming ID, et al., editors. (2002) American Joint Committee on Cancer Staging Manual, 6th edition, Springer-Verlag, New York, 145–150

16.

Japanese Society of Biliary Surgery. (2003) General Rules for Surgical and Pathological Studies on Cancer of the Biliary Tract, 5th Edition, Kanehara, Tokyo,

17.

Albores-Saavedra J, Henson DE, Klimstra DS. (2000) Tumors of the Gallbladder and Extrahepatic Bile Ducts, and Ampulla of Vater, 3rd Edition, Armed Forces Institute of Pathology, Washington, DC, 191–215

18.

Albores-Saavedra J, Henson DE, Sobin LH. (1991) Histological Typing of Tumours of the Gallbladder and Extrahepatic Bile Ducts, Springer-Verlag, Berlin,

19.

Henson DE, Albores-Saavedra J, Corle D. (1992) Carcinoma of the extrahepatic bile ducts. Histologic types, stage of disease, grade, and survival rates. Cancer 70:1498–1501PubMedCrossRef

20.

Albores-Saavedra J, Marakata L, Krueger JE, et al. (2000) Noninvasive and minimally invasive papillary carcinomas of the extrahepatic bile ducts. Cancer 89:508–515PubMedCrossRef

21.

Wakai T, Shirai Y, Moroda T, et al. (2005) Impact of ductal resection status on long-term survival in patients undergoing resection for extrahepatic cholangiocarcinoma. Cancer 103:1210–1216PubMedCrossRef

22.

Kaplan EL, Meier P. (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481CrossRef

23.

Cox D, Oakes D. (1983) Analysis of Survival Data, Chapman and Hall, London,

24.

Schoenthaler R, Phillips TL, Castro J, et al. (1994) Carcinoma of the extrahepatic bile ducts. The University of California at San Francisco experience. Ann Surg 219:267–274PubMedCrossRef

25.

Ebata T, Watanabe H, Ajioka Y, et al. (2002) Pathological appraisal of lines of resection for bile duct carcinoma. Br J Surg 89:1260–1267PubMedCrossRef

26.

Sasaki R, Takahashi M, Funato O, et al. (2001) Prognostic significance of lymph node involvement in middle and distal bile duct cancer. Surgery 129:677–683PubMedCrossRef

27.

Boerma E. (1990) Research into the results of resection of hilar bile duct cancer. Surgery 108:572–580PubMed

28.

Ogura Y, Muzumoto R, Tabata M, et al. (1993) Surgical treatment of carcinoma of the hepatic duct confluence: analysis of 55 resected carcinomas. World J Surg 17:85–93PubMedCrossRef

Title: Significance of Ductal Margin Status in Patients Undergoing Surgical Resection for Extrahepatic Cholangiocarcinoma
Authors: Ryoko Sasaki
Yuichiro Takeda
Osamu Funato
Hiroyuki Nitta
Hidenobu Kawamura
Noriyuki Uesugi
Tamotsu Sugai
Go Wakabayashi
Nobuhiro Ohkohchi
Publication date: 01-09-2007
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 9/2007
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-007-9102-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Significance of Ductal Margin Status in Patients Undergoing Surgical Resection for Extrahepatic Cholangiocarcinoma

Abstract

Objectives

Summary Background Data

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Summary Background Data

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 9/2007

Economics and the Laparoscopic Surgery Learning Curve: Comparison with Open Surgery for Rectosigmoid Cancer

Distribution of Na+/I– Symporter in Thyroid Cancers in an Iodine-deficient Population: An Immunohistochemical Study

Typhoid Intestinal Perforations: Twenty-six Year Experience

Reversal of Diabetes in Mice by Intrahepatic Injection of Bone-derived GFP-murine Mesenchymal Stem Cells Infected with the Recombinant Retrovirus-carrying Human Insulin Gene

Cytoreductive Surgery and Intraperitoneal Chemohyperthermia for Chemoresistant and Recurrent Advanced Epithelial Ovarian Cancer: Prospective Study of 81 Patients

Pyrrolidine Dithiocarbamate Prevents Deleterious Effects of Remote Ischemia/Reperfusion Injury on Healing of Colonic Anastomoses in Rats