Clinicopathological Characteristics and Surgical Outcomes of Primary Cystic Duct Carcinoma: A Multi-institutional Study
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ORIGINAL SCIENTIFIC REPORT
Clinicopathological Characteristics and Surgical Outcomes of Primary Cystic Duct Carcinoma: A Multi-institutional Study Jun Sakata1 • Yuki Hirose1 • Pankaj Prasoon1 • Chie Kitami2 • Masahiro Minagawa3 • Tatsuya Nomura4 • Naoyuki Yokoyama5 • Takashi Aono6 • Kizuki Yuza1 • Kohei Miura1 • Tomohiro Katada1 • Kazuyasu Takizawa1 • Masayuki Nagahashi1 • Takashi Kobayashi1 • Toshifumi Wakai1
Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background The role of surgery in the management of primary cystic duct carcinoma (CDC) remains unclear especially in advanced disease. This study aimed to evaluate long-term outcomes in patients undergoing surgery for primary CDC. Methods From a multi-institutional database, we identified 41 patients who underwent surgery for primary CDC, defined as a part of gallbladder carcinoma with the tumor centre located in the cystic duct. Results Of the 41 patients, 31 (75.6%) underwent preoperative biliary drainage for jaundice. Twenty-eight (68.3%) patients underwent extensive resection including major hepatectomy (n = 21), pancreaticoduodenectomy (n = 4), or both procedures (n = 3). Thirty-four (82.9%) patients had C pT3 tumor, while 31 (75.6%) patients had involvement of contiguous organs/structures. Nodal and distant metastasis was found in 26 (63.4%) and 7 (17.1%) patients, respectively. Most patients (90.2%) had perineural invasion. Median overall survival was 23.7 months in all 41 patients. Factors independently associated with both overall and disease-specific survival were pN (P = 0.003 and P = 0.007, respectively) and pM (P = 0.003 and P = 0.013, respectively) classification. Median survival was 75.3, 17.7, and 5.2 months for patients with pN0M0 (n = 14), pN1/2pM0 or pN0pM1 (n = 21), and pN1/2pM1 (n = 6) disease, respectively (P \ 0.001). Conclusions Primary CDC is characterized by locally advanced disease with aggressive histopathological characteristics at surgery, leading to extensive resection during treatment. Surgery provides potential benefits for patients with pN0pM0 disease, whereas pN1/2 and/or pM1 status appear to have strong adverse effects on survival.
& Jun Sakata [email protected] 1
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan
2
Department of Surgery, Nagaoka Chuo General Hospital, 2041 Kawasaki-cho, Nagaoka, Niigata 940-0861, Japan
3
Department of Surgery, Nagaoka Red Cross Hospital, 2-297-1 Senshu, Nagaoka, Niigata 940-2085, Japan
4
Department of Surgery, Niigata Cancer Center Hospital, 2-15-3 Kawagishi-cho, Chuo-ku, Niigata 951-8566, Japan
5
Department of Surgery, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata 950-1197, Japan
6
Department of Surgery, Niigata Prefectural Central Hospital, 205 Shinnan-cho, Joetsu, Niigata 943-0192, Japan
123
World J Surg
Introduction
Definition of Primary CDC
Since Farrar proposed ‘‘strict’’ diagnostic criteria for primary cystic duct car
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