Clinical Significance of Biliary Intraepithelial Neoplasia-3 (BilIN-3) in Resection Margin of Bile Duct for Perihilar Cholangiocarcinom

Abstract

Introduction: As R0 resection is the most critical concern for the surgery of perihilar cholangiocarcinoma (PHCC), it is still controversial as to whether additional resection of the bile duct is needed on biliary intraepithelial neoplasia-3 (BilIN-3) margin. We aimed to investigate the clinical significance of BilIN-3. Methods: Patients who underwent surgery for PHCC with curative intent between 2000 and 2015 were included in the study and were analyzed retrospectively. We stratified the patients by resection margin status (R0, BilIN-3, R1) and compared the clinical outcomes Results: Overall survival rates for each group at 5 years were 34.5% in the R0 group, 44.4% in the BilIN-3 group, and 21.0% in R1 group, whereas the rates at 10 years were 18.0%, 15.2%, and 11.4% respectively. The recurrence rates at 5 years were 76.4% in the R0 group, 51.7% in the BilIN-3 group, and 88.0% in the R1 group, respectively, while those at 10 years were 83.7%, 83.9%, and 92.8%. Conclusions: The BilIN-3 group showed more similar survival and recurrence patternpatterns to those of the R0 group thanin comparison with the R1 group, but, considering itsthe malignant potential in the late period, BilIN-3 marginmargins should be avoided if technically possible during perihilar cholangiocarcinomaPHCC surgery.