Impact of Remnant Carcinoma in Situ at the Ductal Stump on Long-Term Outcomes in Patients with Distal Cholangiocarcinoma
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ORIGINAL SCIENTIFIC REPORT
Impact of Remnant Carcinoma in Situ at the Ductal Stump on Long-Term Outcomes in Patients with Distal Cholangiocarcinoma Koya Yasukawa1 • Akira Shimizu1 • Hiroaki Motoyama1 • Koji Kubota1 • Tsuyoshi Notake1 • Kentaro Fukushima1 • Tomohiko Ikehara1 • Hikaru Hayashi1 • Akira Kobayashi1 • Yuji Soejima1
Accepted: 15 September 2020 Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background The management of positive ductal margins with carcinoma in situ (R1-CIS) after resection is controversial. The aim of this study was to evaluate the impact of R1-CIS on survival in patients who underwent resection for distal cholangiocarcinoma. Methods We enrolled 121 consecutive patients with distal cholangiocarcinoma. Poor prognostic factors were investigated by multivariable analysis, and we performed a stratified analysis to evaluate the impact of R1-CIS on survival in patients with or without prognostic factors. Results Multivariable analysis identified node-positive status as the prognostic factor (P = 0.003). Stratified by lymph node status, overall survival (OS) in the R0 group was significantly better than that in the R1-CIS group in node-negative patients (57.1% vs 30.0%; P \ 0.050). Although OS was comparable between the two groups in nodepositive patients (5-year OS: 22.2% vs 20.0%, respectively; P = not significant). Furthermore, OS in patients in whom R0 was achieved by additional resection was significantly better than that in patients with R1-CIS (5-year OS: 66.7% vs 30.0%, respectively; P \ 0.050). Conclusions Remnant CIS is associated with a poor prognosis in patients with node-negative distal cholangiocarcinoma. Every effort should be made to achieve negative bile duct margins.
Introduction Complete surgical resection is the only potential way to achieve long-term survival for extrahepatic cholangiocarcinoma [1–3]. Although several prognostic factors for survival after surgical resection have been reported, including bile duct surgical margin status [4], the impact of remnant carcinoma in situ (CIS) at the bile duct margin on long-term survival remains controversial.
& Koya Yasukawa [email protected] 1
Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi 3-11, Matsumoto 390-8621, Japan
Wakai et al. [5] evaluated the influence of ductal margin status on long-term outcomes after surgical resection for extrahepatic cholangiocarcinoma and reported that survival in patients with remnant CIS at the ductal resection margin was comparable to that in patients with negative ductal margins. Several researchers have reported similar results, stating that remnant CIS has no negative impact on longterm survival after resection [6–12]. However, in these studies, the influence of remnant CIS was evaluated in all patients undergoing surgical resection and included various degrees of disease penetrance from early to advanced stages. Recently, several reports have suggested
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