High-grade dysplasia/carcinoma in situ of the bile duct margin in patients with surgically resected node-negative perihilar cholangiocarcinoma is associated with poor survival: a retrospective study.

BACKGROUND

The clinical relevance of a high-grade dysplasia/carcinoma in situ (HD/CIS)-positive bile duct margin in perihilar cholangiocarcinoma (PHC) is unclear. We evaluated the surgical outcomes of PHC patients with HD/CIS.

METHODS

Clinicopathological data of 163 consecutive patients who underwent resection of PHC between 2004 and 2013 were analyzed retrospectively.

RESULTS

Postoperative states included curative resection (R0) with free margins in 113 patients, non-curative resection with HD/CIS (R1-HD/CIS) in 22 patients, and non-curative resection with any invasive carcinoma margin in 28 patients. Multivariate analyses in the entire cohort showed that lymph node metastasis (hazard ratio [HR] 1.91), distant metastasis (HR 3.87), and non-curative resection with any invasive carcinoma margin (vs. R0; HR 2.06) were significant independent prognosticators. However, in node-negative and distant metastasis-negative PHC patients, histology (HR 2.97), R1-HD/CIS (vs. R0; HR 2.31), and non-curative resection with any invasive carcinoma margin (vs. R0; HR 5.33) were significant independent prognosticators. The 2- and 5-year disease-specific survival rates in node-negative and distant metastasis-negative PHC patients with R1-HD/CIS margins were lower compared with those in patients with R0 margins (2-year, 76.7% vs. 84.3%; 5-year, 37.5% vs. 69.3%; P = 0.026).

CONCLUSIONS

R1-HD/CIS should be avoided in patients undergoing surgery for node-negative and distant metastasis-negative PHC.