Impact of ductal resection margin status on long‐term survival in patients undergoing resection for extrahepatic cholangiocarcinoma

Wakai, Toshifumi; Shirai, Yoshio; Moroda, Tetsuya; Yokoyama, Naoyuki; Hatakeyama, Katsuyoshi

doi:10.1002/cncr.20906

Cited by 215 publications

(226 citation statements)

References 24 publications

Supporting

Mentioning

217

Contrasting

Unclassified

Order By: Relevance

“…26, 27, 28, 31, 32, 34, 35, 38 The reported incidences of complete resection with histopathologically negative margins ranged from 69% to 87% 26, 27, 28, 31, 32, 34, 35, 38. All the studies included in Table 1 confirmed that ductal resection margin status was an independent prognostic factor in patients with extrahepatic cholangiocarcinoma.…”

Section: Biological Behavior Of Residual Carcinoma In Situmentioning

confidence: 81%

“…Differentiation between severe dysplasia and carcinoma in situ may be difficult or impossible. Therefore, in several clinical studies,26, 27, 28, 35, 36, 38, 39 severe (high‐grade) dysplasia has been categorized as carcinoma in situ. Severe dysplastic epithelium or carcinoma in situ may extend into intramural glands such as the sacculi of Beale or metaplastic pyloric type glands 42.…”

Section: “Carcinoma In Situ”: Histopathological Terminologymentioning

confidence: 99%

“…All the studies included in Table 1 confirmed that ductal resection margin status was an independent prognostic factor in patients with extrahepatic cholangiocarcinoma. Residual invasive carcinoma at the ductal resection margins (median survival time, 12‐21 months) has been reported to influence patient survival after surgical resection for extrahepatic cholangiocarcinoma more adversely than residual carcinoma in situ (median survival time, 29‐99 months) 26, 27, 28, 31, 32, 34, 38. Several research groups reported that survival following resection was comparable between patients who had negative ductal margins (median survival time, 33‐55 months) and those who had positive ductal margins with carcinoma in situ (median survival time, 37‐99 months) 26, 27, 28, 31, 32, 35.…”

Section: Biological Behavior Of Residual Carcinoma In Situmentioning

confidence: 99%

“…Residual invasive carcinoma at the ductal resection margins (median survival time, 12‐21 months) has been reported to influence patient survival after surgical resection for extrahepatic cholangiocarcinoma more adversely than residual carcinoma in situ (median survival time, 29‐99 months) 26, 27, 28, 31, 32, 34, 38. Several research groups reported that survival following resection was comparable between patients who had negative ductal margins (median survival time, 33‐55 months) and those who had positive ductal margins with carcinoma in situ (median survival time, 37‐99 months) 26, 27, 28, 31, 32, 35. Although residual carcinoma in situ at the ductal margins does not have a strong adverse effect on survival in patients with extrahepatic cholangiocarcinoma, it may result in late local recurrence 26, 27, 28, 29, 31, 32, 34, 36, 53, 54, 55, 56, 57…”

Section: Biological Behavior Of Residual Carcinoma In Situmentioning

confidence: 99%

“…Ductal resection margin status is an established prognostic indicator,13, 14 and survival following resection in patients with positive ductal margins has generally been deemed unsatisfactory 10, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25. In 2005, Wakai et al26 reported that invasive carcinoma at the ductal resection margins had a strong adverse effect on survival in patients with extrahepatic cholangiocarcinoma, whereas residual carcinoma in situ did not. Thereafter, similar results were reported in Japan,27, 28, 29, 30, 31, 32, 33, 34, 35, 36 the USA,37 South Korea,38, 39 and Germany 40.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

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

Self Cite

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