Department of Surgery and Cancer Research Institute, Seoul National University, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, South Korea.
J Gastrointest Surg. 2014 Jun;18(6):1146-54. doi: 10.1007/s11605-014-2518-0. Epub 2014 Apr 19.
BACKGROUND/PURPOSE: Surgical resection is the only curative treatment for extrahepatic bile duct (EHBD) cancer, but guidelines for optimal resection margins have not yet been established. Therefore, the purpose of this study is to analyze the patterns of microscopic tumor spreads and their lengths according to gross morphology and to suggest optimal resection margins for EHBD cancer.
A total of 79 patients with EHBD cancers who underwent curative resection at Seoul National University Hospital between 2007 and 2010 were reviewed. Pathologic findings were reviewed by a single specialized pathologist.
Mucosal and mural/perimural spreads were seen in 37.3 and 62.3 %, respectively. The mean length of tumor spreads in the papillary (n = 13), nodular/nodular infiltrative (n = 43), and sclerosing types (n = 23) were 4.5 ± 6.3, 1.8 ± 6.4, and 6.4 ± 6.7 mm, respectively. Spread patterns correlated with gross morphologies (P < 0.001). The lengths of tumor spreads at the 90th percentile were 15.6, 10.0, and 15.6 mm, respectively.
The patterns of tumor spreads correlated with gross morphologies. Optimal resection margins in EHBD cancers should be 16 mm in the papillary and sclerosing types and 10 mm in the nodular/nodular infiltrative type.
背景/目的：手术切除是治疗肝外胆管（EHBD）癌的唯一根治性治疗方法，但尚未制定最佳切除边界的指南。因此，本研究的目的是根据大体形态分析肿瘤微观扩散的模式及其长度，并为 EHBD 癌提出最佳的切除边界。
回顾性分析 2007 年至 2010 年在首尔国立大学医院接受根治性切除的 79 例 EHBD 癌患者。由一名专门病理学家对病理发现进行了审查。
黏膜和壁内/壁周扩散分别为 37.3%和 62.3%。乳头型（n=13）、结节/结节浸润型（n=43）和硬化型肿瘤扩散的平均长度分别为 4.5±6.3、1.8±6.4 和 6.4±6.7mm。肿瘤扩散模式与大体形态相关（P<0.001）。肿瘤扩散长度的第 90 百分位数分别为 15.6、10.0 和 15.6mm。
肿瘤扩散模式与大体形态相关。EHBD 癌的最佳切除边界应在乳头型和硬化型中为 16mm，在结节/结节浸润型中为 10mm。
