Impact of Remnant Carcinoma in Situ at the Ductal Stump on Long-Term Outcomes in Patients with Distal Cholangiocarcinoma

• Published in: World journal of surgery Vol. 45; no. 1; pp. 291 - 301
• Main Authors: Yasukawa, Koya, Shimizu, Akira, Motoyama, Hiroaki, Kubota, Koji, Notake, Tsuyoshi, Fukushima, Kentaro, Ikehara, Tomohiko, Hayashi, Hikaru, Kobayashi, Akira, Soejima, Yuji
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 2021; Springer Nature B.V
• Subjects: Abdominal Surgery; Bile ducts; Cardiac Surgery; Cholangiocarcinoma; General Surgery; Lymph nodes; Medical prognosis; Medicine; Medicine & Public Health; Original Scientific Report; Surgery; Survival; Thoracic Surgery; Vascular Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-020-05799-2

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 node-positive 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.