Residual Carcinoma In Situ at the Ductal Stump has a Negative Survival Effect

Abstract

R1cis increases the incidence of local recurrence and shortens postoperative survival in patients with early-stage cholangiocarcinoma, although this prognostic effect was less severe compared with R1inv. R1cis should be avoided as much as possible in surgery for early-stage cancer, although it may be allowed in advanced tumors.

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.…”

“…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…”

“…In 2011, Wakai et al58 reported that after stratification based on pN and pM classification, the ductal resection margin status in patients with extrahepatic cholangiocarcinoma significantly influenced long‐term survival following resection in those with pN0pM0 disease but not in those with pN1 and/or pM1 disease. When the ductal resection margin status is shown to be carcinoma‐positive on examination of frozen sections, additional resection should be considered in patients with localized (pN0pM0) disease 28, 34, 36, 47, 58, 59, 60. In 2017, Tsukahara et al34 first reported that residual carcinoma in situ at the bile duct stumps increased the incidence of local recurrence and adversely affected postoperative survival in patients who underwent resection for early‐stage (pTis‐2N0M0) cholangiocarcinoma.…”