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Histologic bile duct invasion by a mass-forming intrahepatic cholangiocarcinoma
Kazuhiro Hirohashi1, Takahiro Uenishi, Shoji Kubo
1Department of Hepato-Biliary-Pancreatic and Gastroenterological Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan.
Background/Purpose:
Although curative surgical resection provides the best chance of long-term survival for patients with intrahepatic cholangiocarcinoma, the presence of bile duct invasion decreases postoperative survival rates in patients with mass-forming intrahepatic cholangiocarcinoma. We carried out this study to determine a surgical strategy for patients with bile duct invasion of these tumors.
Methods:
Forty-one patients with mass-forming intrahepatic cholangiocarcinoma were classified as either having bile duct invasion ( n = 26) or not having bile duct invasion ( n = 15). Clinicopathologic findings, including postoperative outcomes, were compared between these two groups.
Results:
Perineural invasion, lymphatic invasion, and a positive resection margin were more frequent in patients with ductal invasion. Patients with ductal invasion had lower survival rates than those without ductal invasion.
Conclusions:
Intraoperative frozen section examination of the bile duct stump to confirm a clear resection margin is required in patients with mass-forming tumors. Resection of the extrahepatic bile duct should be considered when tumor cells are identified at the surgical margin of the resected bile duct.