Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan.
World J Surg. 2021 Jan;45(1):291-301. doi: 10.1007/s00268-020-05799-2. Epub 2020 Sep 28.
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.
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.
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).
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.
切除术后伴原位癌（R1-CIS）的阳性胆管切缘的处理存在争议。本研究旨在评估切除术后远端胆管癌患者中 R1-CIS 对生存的影响。
我们纳入了 121 例连续的远端胆管癌患者。采用多变量分析探讨预后不良因素，并进行分层分析以评估 R1-CIS 对有或无预后因素的患者生存的影响。
多变量分析发现淋巴结阳性状态是预后因素（P=0.003）。根据淋巴结状态分层，在淋巴结阴性患者中，R0 组的总生存期（OS）明显优于 R1-CIS 组（57.1% vs 30.0%；P<0.050）。尽管在淋巴结阳性患者中两组的 OS 无差异（5 年 OS：分别为 22.2%和 20.0%；P=不显著）。此外，通过额外切除实现 R0 的患者的 OS 明显优于 R1-CIS 患者（5 年 OS：分别为 66.7%和 30.0%；P<0.050）。
对于淋巴结阴性的远端胆管癌患者，残留 CIS 与预后不良相关。应尽一切努力获得阴性胆管切缘。
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