Clinical relevance of frozen diagnosis of ductal margins in surgery of bile duct cancer

Furukawa, Toru; Higuchi, Ryota; Yamamoto, Masakazu

doi:10.1002/jhbp.73

Cited by 12 publications

(7 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Patients with R0 margins had a decreased risk of early recurrence in our study compared with those with R1 margins. This finding has further stressed the importance of R0 resection to prevent early recurrence; to guarantee R0 resection, measures such as intra-operative frozen-section examination should be routinely performed [30]. Because radical resection for type IV pCCA is considered technically challenging, it was encouraging to find that the R0 resection rate was 67.2% in our study.…”

Section: Discussionsupporting

confidence: 51%

A simple scoring system to predict early recurrence of Bismuth–Corlette type IV perihilar cholangiocarcinoma

Peng

et al. 2019

Gastroenterology Report

View full text Add to dashboard Cite

BackgroundEarly recurrence has been reported to be predictive of a poor prognosis for patients with perihilar cholangiocarcinoma (pCCA) after resection. The objective of our study was to construct a useful scoring system to predict early recurrence for Bismuth–Corlette type IV pCCA patients in clinic and to investigate the value of early recurrence in directing post-operative surveillance and adjuvant therapy.MethodsIn total, 244 patients who underwent radical resection for type IV pCCA were included. Data on clinicopathological characteristics, perioperative details and survival outcomes were analyzed. Survival curves were generated using the Kaplan–Meier method. Univariate and multivariate logistic-regression models were used to identify factors associated with early recurrence.ResultsTwenty-one months was defined as the cutoff point to distinguish between early and late recurrence. Univariate and multivariate analysis revealed that CA19-9 level >200 U/mL, R1 resection margin, higher N category and positive lymphovascular invasion were independent predictors of early recurrence. The scoring system was constructed accordingly. The early-recurrence rates of patients with scores of 0, 1, 2, 3, 4, and 5 were 23.9%, 38.7%, 60.0%, 78.6%, 83.4%, and 100%, respectively. Adjuvant therapy was significantly associated with higher overall survival rate for patients with early recurrence, but not for those with late recurrence. Patients in the early-recurrence group with scores ≥2 had better prognoses after adjuvant therapy.ConclusionsA simple scoring system using CA19-9 level, N category, resection margin and lymphovascular invasion status could predict early recurrence, and thus might direct post-operative surveillance and adjuvant therapy for patients with type IV pCCA.

show abstract

Section: Discussionsupporting

confidence: 51%

A simple scoring system to predict early recurrence of Bismuth–Corlette type IV perihilar cholangiocarcinoma

Peng

et al. 2019

Gastroenterology Report

View full text Add to dashboard Cite

show abstract

“…This finding further stresses on the importance of R0 resection to prevent early recurrence and that, to guarantee R0 resection, measurements such as intraoperative frozen section examination should be routinely performed if possible. 41 Several limitations of the current study should be considered. This was a retrospective and uncontrolled study that was conducted at a single center, which means that a selection bias was inevitable.…”

Section: Univariate and Multivariate Analysis Of Clinicopathologic Inmentioning

confidence: 92%

Lymphocyte to Monocyte Ratio Predicts Resectability and Early Recurrence of Bismuth-Corlette Type IV Hilar Cholangiocarcinoma

Peng

et al. 2020

Journal of Gastrointestinal Surgery

View full text Add to dashboard Cite

Background The objective of our research was to investigate the value of the lymphocyte to monocyte ratio (LMR) and its dynamic changes (LMRc) in predicting tumor resectability and early recurrence of radiologically resectable type IV hilar cholangiocarcinoma (HC). Methods A total of 411 patients with radiologically resectable type IV HC were included. Data on their clinicopathologic characteristics, perioperative features, and survival outcomes were analyzed. Receiver operating characteristic (ROC) analysis was conducted to assess the ability of preoperative LMR (pre-LMR) to predict tumor resectability, and the ability of postoperative LMR (post-LMR) to discriminate between early and late recurrence. Survival curves were calculated using the Kaplan-Meier estimate. Univariate and multivariate logistic regression models were used to identify factors associated with resectability and early recurrence. Results Of 411 patients with potentially curative type IV HC, 254 underwent curative surgery. The optimal cutoff value of pre-LMR as an indicator of resectability was 3.67, and the optimal cutoff value of post-LMR for detecting early recurrence was 4.10. In the multivariate logistic regression model, CA19-9 > 200 U/mL, pre-LMR ≤ 3.67, and tumor size > 3 cm were found to be independent risk factors for poor resectability. Moreover, multivariate analysis showed that LMRc, resection margin, AJCC N stage, and lymphovascular invasion were independent risk factors associated with early recurrence. Discussion Pre-LMR is a valuable indicator of resectability and LMRc is a valuable predictor of early recurrence in patients with curative type IV HC.

show abstract

“…Ductal resection margin status in patients with extrahepatic cholangiocarcinoma has traditionally been evaluated intraoperatively by histological examination of frozen sections 26, 27, 29, 33, 37, 61, 62. In 2009, Konishi et al30 proposed a new histological classification of ductal resection margins on intraoperative frozen‐section examination in cholangiocarcinoma.…”

Section: Intraoperative Histological Examination Of Ductal Resection mentioning

confidence: 99%

Surgical management of carcinoma in situ at ductal resection margins in patients with extrahepatic cholangiocarcinoma

Wakai

Sakata

Katada

et al. 2018

Annals of Gastroent Surgery

View full text Add to dashboard Cite

Recent advances in dimensional imaging, surgical technique, and perioperative patient care have resulted in increased rates of complete resection with histopathologically negative margins and improved surgical outcomes in patients with extrahepatic cholangiocarcinoma. However, achieving cancer‐free resection margins at ductal stumps in surgery for this disease remains challenging because of longitudinal extension, which is one of the hallmarks of extrahepatic cholangiocarcinoma. When the ductal resection margins are shown to be positive on examination of frozen sections, discrimination between carcinoma in situ and invasive carcinoma is clinically important because residual carcinoma in situ may lead to late local recurrence whereas residual invasive carcinoma is associated with early local recurrence. Residual invasive carcinoma at the ductal margins should be avoided whenever technically feasible. Residual “carcinoma in situ” at the ductal margins appears to be allowed in resection for the advanced disease because it has less effect on survival than other adverse prognostic factors (pN1 and/ or pM1). However, in surgery for early‐stage (pTis‐2N0M0) extrahepatic cholangiocarcinoma, residual carcinoma in situ at the ductal margins may have an adverse effect on long‐term survival, so should be avoided whenever possible. In this review, we focus on the histopathological term “carcinoma in situ,” the biological behavior of residual carcinoma in situ at ductal resection margins, intraoperative histological examination of the ductal resection margins, outcome of additional resection for positive ductal margins, and adjuvant therapy for patients with positive margins.

show abstract

Clinical relevance of frozen diagnosis of ductal margins in surgery of bile duct cancer

Cited by 12 publications

References 13 publications

A simple scoring system to predict early recurrence of Bismuth–Corlette type IV perihilar cholangiocarcinoma

A simple scoring system to predict early recurrence of Bismuth–Corlette type IV perihilar cholangiocarcinoma

Lymphocyte to Monocyte Ratio Predicts Resectability and Early Recurrence of Bismuth-Corlette Type IV Hilar Cholangiocarcinoma

Surgical management of carcinoma in situ at ductal resection margins in patients with extrahepatic cholangiocarcinoma

Contact Info

Product

Resources

About