Study of the intrahepatic surgical margin of hilar bile duct carcinoma.

BACKGROUND/AIMS: The diagnosis and treatment for hilar bile duct carcinoma has greatly improved. Frozen section is one of the modalities used to determine the intrahepatic surgical margin and the surgical approach for tumor resection. But we are sometimes faced with the case where we are perplexed whether to carry out additional surgical resection or not according to the result of frozen section, due to its inaccuracy. We studied herein the relation between the prognosis and the intrahepatic surgical margin according to the result of frozen section.

METHODOLOGY

We reviewed 23 cases of hilar bile duct carcinoma whose intrahepatic surgical margin was determined by frozen section and studied the cause of death and surgical procedure. Results of the frozen sections were compared with the permanent paraffin sections.

RESULTS

The overall survival rates at 1, 3 and 5 years after operation were 68.1, 41.3, and 33.0%, respectively. The accuracy, sensitivity and specificity of frozen section was 56.5%, 75.0%, and 46.7%, respectively.

CONCLUSIONS

We concluded that by evaluating the diagnosis of frozen section during the surgery it was difficult to determine intrahepatic surgical margin. Aggressive hepatic resection sometimes causes a high risk of hepatic failure in which case the histological diagnosis of the frozen section throughout should not be carried out.