Pathologic staging of pancreatic, ampullary, biliary, and gallbladder cancers: pitfalls and practical limitations of the current AJCC/UICC TNM staging system and opportunities for improvement

Adsay, Volkan; Bağcı, Pelin; Tajiri, Takuma; Oliva, Irma; Ohike, Nobuyuki; Balcı, Serdar; González, Raúl; Basturk, Olca; Jang, Kee–Taek; Roa, Juan Carlos

doi:10.1053/j.semdp.2012.08.010

Cited by 125 publications

(98 citation statements)

References 37 publications

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“…If a pathologist considers the duodenal mucosa and submucosa as part of the ''duodenal wall,'' a small invasive carcinoma arising from papilla of Vater could be classified as T2, whereas a much larger invasive carcinoma confined to the sphincter of Oddi muscle would have to be regarded as T1. 3 Although there are no data, to our knowledge, we suspect there might be meaningful personal variation in definitions and interpretations of duodenal wall invasion in ACs. In this study, we found some ACs with perisphincteric or duodenal submucosal invasion that were classified as T1 and other cases where they were classified T2.…”

Section: The Most Confusing Point In T Classification Of Acs Is the Vmentioning

confidence: 84%

“…We think a standardized gross protocol for AC is crucial for the exact evaluation of tumor invasion in AC. Adsay et al 3,6 also suggested that perpendicular gross sectioning with 2 probes along the common bile and pancreatic ducts may be best way to examine invasion by AC. The depth of tumor invasion (T classification) has been reported as an independent prognostic factor in many previous studies.…”

Section: The Most Confusing Point In T Classification Of Acs Is the Vmentioning

confidence: 99%

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Pathologic T1 Subclassification of Ampullary Carcinoma With Perisphincteric or Duodenal Submucosal Invasion: Is It T1b?

You

Heo

Choi

et al. 2014

Archives of Pathology &Amp; Laboratory Medicine

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Context.-In ampullary carcinoma staging, T1 is defined as a tumor limited to the ampulla of Vater or the sphincter of Oddi, and T2 is defined as invasion into the duodenal wall. However, the definition of duodenal wall invasion is vague. Ampullary carcinoma that invades beyond the sphincteric of Oddi (perisphincteric invasion) or into the duodenal submucosa could be considered pT1b because submucosal invasion is classified as pT1b in gastrointestinal tract tumors. However, there are no data regarding T subclassifications for ampullary carcinoma with perisphincteric or duodenal submucosa invasion.Objective.-To determine the T subclassification of ampullary carcinoma that invades into perisphincteric or duodenal submucosa.Design.-Pathologically proven ampullary carcinomas with T1 or T2 were reviewed (n ¼ 105). We reclassified tumors as pT1a that were limited to within the sphincter of Oddi (n ¼ 40; 38%), as pT1b for tumors that invaded beyond the sphincter of Oddi or into the duodenal submucosa (n ¼ 25; 24%), and as pT2 for tumors that invaded into duodenal proper muscle (n ¼ 40; 38%).Results.-Lymph node metastasis and recurrence were absent in ampullary carcinoma with pT1a, whereas nodal metastasis were noted in 24% (6 of 25) and 40% (16 of 40) of the ampullary carcinomas with pT1b and pT2, respectively. Tumor recurrence/metastasis rate of ampullary carcinoma with pT1b and pT2 was 44% (11 of 25) and 40% (16 of 40), respectively. The 5-year disease-freesurvival rates from ampullary carcinoma with pT1a, pT1b, and pT2 were 95% (38 of 40), 56% (14 of 25), and 58% (23 of 40), respectively (P ¼ .003). The 5-year overall survival from ampullary carcinoma with pT1a, pT1b, and pT2 was 98% (39 of 40), 72% (18 of 25), and 60% (24 of 40), respectively.Conclusions.-The clinicopathologic outcome of ampullary carcinoma with a pT1b subclassification was worse than it was for T1a and approached the outcome for pT2.

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Section: The Most Confusing Point In T Classification Of Acs Is the Vmentioning

confidence: 84%

Section: The Most Confusing Point In T Classification Of Acs Is the Vmentioning

confidence: 99%

Pathologic T1 Subclassification of Ampullary Carcinoma With Perisphincteric or Duodenal Submucosal Invasion: Is It T1b?

You

Heo

Choi

et al. 2014

Archives of Pathology &Amp; Laboratory Medicine

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“…An upper gastrointestinal (GI) series on postoperative day 8 demonstrated smooth passage of the contrast material through the entire duodenum to the jejunum. Histological examination of the surgical specimen revealed the two pathologies: a cholangiocarcinoma with stage IA of T1N0M0 (Figure 5A) and a gallbladder cancer with stage II of T2N0M0, according to the American Joint Committee on Cancer Control (AJCC) TNM classification 9. The tumor extended horizontally close to Vater's ampulla (Figure 5B); however, all cut end margins and dissected margins were negative for tumor cells.…”

Section: Resultsmentioning

confidence: 99%

Pancreas‐preserving resection of lower biliary tract adenocarcinoma: A coring‐out technique

Nishida

Sugimoto

Kojima

et al. 2017

Annals of Gastroent Surgery

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Surgical resection for distal cholangiocarcinoma is usually carried out using pancreaticoduodenectomy (PD). However, because PD is a complex procedure with a high rate of postoperative complications, the surgical indications should be carefully considered, especially for patients with a decreased performance status, significant comorbidities, and/or anatomical anomalies. If curatively carried out, a less invasive, local resection may be an alternative procedure for such patients. In the current study, we present pancreas‐preserving resection of the lower biliary tract in a patient with early‐stage distal cholangiocarcinoma. This procedure was selected to avoid PD with arterial reconstruction because of arterial anomalies. After an abdominal exploration, a cholecystectomy was carried out and the common hepatic duct was transected. The bile duct was dissected from the pancreatic parenchyma without pancreatic resection, downward to the biliopancreatic ductal confluence. Next, a duodenotomy was done opposite Vater's ampulla. The duodenal mucosa around Vater's ampulla was incised and dissected, and the main pancreatic duct (MPD) was divided. The bile duct was completely separated from the pancreatic parenchyma, and the lower biliary tract was totally “cored‐out”. After resection, the MPD was re‐implanted into the duodenal wall, and the duodenotomy was closed. Finally, a Roux‐en‐Y hepaticojejunostomy was created. Postoperative course was uneventful. No tumor recurrence has been observed for 21 months after the operation. Thus, pancreas‐preserving resection of the lower biliary tract appeared to be appropriate for our patient. This organ‐preserving approach can be a useful, alternative procedure in selected patients.

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“…Over the past several decades, advances in anesthesia, operative techniques, and care have led to marked improvements in perioperative and postoperative outcomes [141e143]: for this reason, the decision to resect a patient in an M1 situation should be carefully assessed and may be an option in highly [15]. According with AJCC/UICC staging system [94], stratification of M is actually limited to the conditions of M0 and M1 but patients with PA had various presentation of the M1 category.…”

Section: Discussionmentioning

confidence: 99%

“…A rare case of local relapse might be caused by an incomplete resection, distant metastases and peritoneal carcinosis ultimately depend on a dissemination of malignant cells and those cells are often not detectable with conventional diagnostic tools [89e93]. Nowadays, the current standings AJCC/UICC staging system attributes the item M for metastatic disease, but does not consider the site and number of the distant metastases by PA [94].…”

Section: Stagingmentioning

confidence: 99%

Metastases of pancreatic adenocarcinoma: A systematic review of literature and a new functional concept

Cannistrà

Ruggiero

Zullo

et al. 2015

International Journal of Surgery

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Pathologic staging of pancreatic, ampullary, biliary, and gallbladder cancers: pitfalls and practical limitations of the current AJCC/UICC TNM staging system and opportunities for improvement

Cited by 125 publications

References 37 publications

Pathologic T1 Subclassification of Ampullary Carcinoma With Perisphincteric or Duodenal Submucosal Invasion: Is It T1b?

Pathologic T1 Subclassification of Ampullary Carcinoma With Perisphincteric or Duodenal Submucosal Invasion: Is It T1b?

Pancreas‐preserving resection of lower biliary tract adenocarcinoma: A coring‐out technique

Metastases of pancreatic adenocarcinoma: A systematic review of literature and a new functional concept

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