Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 6, 2022; 10(10): 3078-3087
Published online Apr 6, 2022. doi: 10.12998/wjcc.v10.i10.3078
Significance of dysplasia in bile duct resection margin in patients with extrahepatic cholangiocarcinoma: A retrospective analysis
Jung Wan Choe, Hyo Jung Kim, Jae Seon Kim
Jung Wan Choe, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan 15355, South Korea
Hyo Jung Kim, Jae Seon Kim, Department ofInternal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul 08308, South Korea
Author contributions: Kim HJ designed the study; Kim HJ drafted the work; Kim JS, Kim HJ, and Choe JW collected the data; Choe JW analyzed and interpreted the data and wrote the article.
Supported by the National Research Foundation of Korea, No. 2019R1C1C1003661.
Institutional review board statement: The study was reviewed and approved by the Korea University Ansan Hospital (2021AS0282).
Informed consent statement: The requirement for informed consent was waived by the committee because of the retrospective nature of the study.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hyo Jung Kim, MD, PhD, Professor, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul 08308, South Korea. hjkimmd@korea.ac.kr
Received: September 27, 2021
Peer-review started: September 29, 2021
First decision: December 17, 2021
Revised: December 24, 2021
Accepted: February 15, 2022
Article in press: February 15, 2022
Published online: April 6, 2022
Processing time: 183 Days and 4.1 Hours
Abstract
BACKGROUND

Radical resection is the only indicator associated with survival in extrahepatic cholangiocarcinoma (EHCC). However, limited data are available regarding the implications of dysplasia at the resection margin following surgery.

AIM

To evaluate the prognostic significance of dysplasia-positive margins in patients diagnosed with EHCC.

METHODS

We reviewed the records of patients who had undergone surgery for EHCC with curative intent between January 2013 and July 2017. We retrospectively analyzed the clinicopathological data of 116 patients followed for longer than 3 years. The status of resection margin was used to classify patients into negative low-grade dysplasia (LGD) and high-grade dysplasia (HGD)/carcinoma in situ (CIS) categories.

RESULTS

Based on postoperative status, 72 patients underwent resection with negative margins, 19 had LGD-positive margins, and 25 showed HGD/CIS-positive margins. The mean survival rates of the patients with negative margins, LGD margins, and HGD/CIS margins were 49.1 ± 4.5, 47.3 ± 6.0, and 20.8 ± 4.4 mo, respectively (P < 0.001). No difference in survival was found between groups with LGD margins and negative margins (P = 0.56). In the multivariate analysis, age > 70 years and HGD/CIS-positive margins were significant independent factors for survival (hazard ratio = 1.90 and 2.47, respectively).

CONCLUSION

HGD/CIS margin in resected EHCC is associated with a poor survival. However, the LGD-positive resection margin is not a significant indicator of survival in patients with EHCC.

Keywords: Dysplasia, Cholangiocarcinoma, Survival, Extrahepatic cholangiocarcinoma, Low-grade dysplasia, High-grade dysplasia

Core Tip: This study indicated that the status of the bile duct resection margin in operable extrahepatic cholangiocarcinoma (EHCC) is an important indicator of recurrence and survival. High-grade dysplasia/carcinoma in situ margin in resected EHCC was associated with a poor survival and high tumor recurrence. However, low-grade dysplasia positive margin was not a significant prognostic factor in patients with EHCC.