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DIPLOMA Approach for Standardized Pathology Assessment of Distal Pancreatectomy Specimens
Published on: February 1, 2020
Ductal Margin Distance Is a Stronger Prognostic Indicator than Margin Status After Curative Resection of Distal
Yeongsoo Jo1, Yoo-Seok Yoon2, Ho-Seong Han2
1Department of Surgery, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul 07804, Republic of Korea.
Background:
Distal cholangiocarcinoma (dCCA) has a poor prognosis and the prognostic impact of ductal margin status, particularly carcinoma in situ (CIS) or high-grade dysplasia (HGD) at the margin, remains controversial. This retrospective single-center study evaluated whether ductal margin distance (DMD) is a stronger prognostic indicator than ductal margin status (DMS) after curative resection.
Methods:
We reviewed 416 patients who underwent pancreaticoduodenectomy for distal cholangiocarcinoma between 2003 and 2022. DMS was classified as negative, CIS/HGD, or invasive carcinoma (IC). The DMD was defined pathologically as the linear distance from the proximal ductal margin to IC and patients were divided into two groups using 10 mm as the cut-off. Survival was analyzed with Kaplan-Meier and Cox regression.
Results:
Overall, 349, 52, and 15 patients had negative, CIS/HGD, and IC margins, and 249 and 167 had DMD > 10 and ≤10 mm, respectively. Overall survival (OS) and disease-free survival (DFS) did not differ significantly according to DMS, whereas DMD ≤ 10 mm was associated with significantly worse 5-year OS (48.5% vs. 67.9%) and DFS (39.9% vs. 55.9%). On multivariable analysis, DMD ≤ 10 mm was an independent adverse prognostic factor for both OS (hazard ratio 1.669; p = 0.003) and DFS (hazard ratio 1.394; p = 0.026).
Conclusions:
DMD demonstrated a stronger association with prognosis than DMS in patients with negative or CIS/HGD at the ductal resection margin following dCCA resection. A DMD of ≤10 mm was significantly associated with decreased OS and DFS. Well-designed prospective studies are warranted to validate these results.
