Impact of residual in situ carcinoma on postoperative survival in 125 patients with extrahepatic bile duct carcinoma

Abstract

Purpose: 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.

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

“…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. These findings indicate that discrimination between carcinoma in situ and invasive carcinoma is critical when the ductal resection margins are found to be positive on intraoperative examination of frozen sections; residual carcinoma in situ may lead to late local recurrence, whereas residual invasive carcinoma results in early local recurrence 26…”

“…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.…”

“…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.…”

“…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…”

“…Some authors have reported a statistically significant association of status of the ductal resection margins with local recurrence 27, 31, 32. However, the likelihood of recurrence depends on the duration of follow up.…”