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Reappraisal of carcinoma in situ residue at the bile duct margin: a single-center review of 681 patients with perihilar cholangiocarcinoma

  • 0Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Pathology and Clinical Laboratories, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Hpb : the Official Journal of the International Hepato Pancreato Biliary Association +

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December 25, 2024

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December 25, 2024

View abstract on PubMed

Summary

This summary is machine-generated.

In perihilar cholangiocarcinoma resection, a positive margin with carcinoma in situ (R1cis) significantly worsens survival, though less than invasive carcinoma (R1inv). This finding impacts surgical strategy and patient prognosis for bile duct cancer.

Area Of Science

  • Oncology
  • Surgical Pathology
  • Hepatobiliary Surgery

Background

  • Surgical margins are critical in cholangiocarcinoma resection.
  • A positive margin (R1) is common, but its prognostic impact varies.
  • The effect of R1 with carcinoma in situ (R1cis) on survival is debated compared to invasive carcinoma (R1inv).

Purpose Of The Study

  • To evaluate the prognostic significance of R1cis compared to R0 (negative margin) and R1inv in perihilar cholangiocarcinoma.
  • To clarify the survival impact of different margin statuses after resection.

Main Methods

  • Retrospective review of 681 patients undergoing perihilar cholangiocarcinoma resection (2002-2019).
  • Classification of duct margins as R0, R1cis, or R1inv.
  • Comparison of recurrence and survival rates based on margin status.

Main Results

  • R1inv had the highest 5-year recurrence (82.8%), followed by R1cis (67.8%) and R0 (47.6%).
  • Five-year survival was significantly worse for R1cis (37.3%) than R0 (56.7%) and better than R1inv (20.9%).
  • Multivariate analysis identified R1cis as an independent predictor of poorer survival (HR 1.65).

Conclusions

  • R1cis significantly deteriorates overall survival in perihilar cholangiocarcinoma resection compared to R0.
  • The negative prognostic impact of R1cis is less severe than that of R1inv.
  • These findings underscore the importance of achieving negative margins in cholangiocarcinoma surgery.