Abstract
BackgroundIntraoperative frozen section (FS) is broadly used during pancreaticoduodenectomy (PD) to ensure a negative margin status, but its survival benefits on obtaining a secondary R0 resection for distal cholangiocarcinoma (dCCA) is controversial and unclear.MethodsClinical data of 107 patients who underwent PD for dCCA was retrospectively collected and divided into different groups based on use of FS (FS and non-FS groups) and status of resection margin (pR0, sR0 and R1 groups), and clinical parameters and survival of patients were compared and analyzed accordingly.ResultsThere were 50 patients in FS group with a median survival of 28 months, 57 patients in non-FS group with a median survival of 27 months. There was no statistical difference between the two groups with Kaplan-Meier survival analysis (P = 0.347). There were 98 patients in R0 group (88 in pR0 and 10 in sR0) and nine patients in R1 group, with a median survival of 29 months and 22 months respectively, which showed a better survival in R0 group than in R1 group (P = 0.006). Survival analyses between subgroups revealed difference between pR0 and R1 group (P = 0.005), while no statistical difference concerning pR0 vs. sR0 (P = 0.211) and sR0 vs. R1 groups (P = 0.262). Multivariate Cox regression analysis revealed resection margin status, pre-operative biliary drainage and lymph node invasion to be independent prognostic factors for dCCA patients.ConclusionsIntraoperative FS should be recommended as it significantly increased the rate of R0 resection, which was positively related to a better survival. A primary R0 resection should also be encouraged and if not, a secondary R0 could be considered at the discretion of surgeons as it showed similar survival with primary R0 resection.
Highlights
Cholangiocarcinoma (CCA), a cancer arising from epithelium of biliary tract, is the most common malignancy in biliary duct system and the second common primary liver malignancy in the whole hepatobiliary system after hepatocellular carcinoma (HCC), accounting for about 3% of all gastrointestinal tumors and 10% to 15% of hepatobiliary malignancies [1, 2]
A retrospective analysis was conducted on patients who underwent PD for distal CCA (dCCA) in the General Surgery Department of Qilu Hospital (Cheeloo College of Medicine, Shandong University) from January 2011 to November 2019. dCCA was defined as carcinoma arising from distal part of extrahepatic bile duct that was below insertion of cystic duct
Primary analysis was performed between frozen section (FS) and non-FS groups in order to view if the use of FS had some impact on patient overall survival
Summary
Cholangiocarcinoma (CCA), a cancer arising from epithelium of biliary tract, is the most common malignancy in biliary duct system and the second common primary liver malignancy in the whole hepatobiliary system after hepatocellular carcinoma (HCC), accounting for about 3% of all gastrointestinal tumors and 10% to 15% of hepatobiliary malignancies [1, 2]. According to the updated 3rd edition of International Classification Diseases for Oncology (ICD-O) system, CCA are categorized into intrahepatic CCA (iCCA), perihilar CCA (pCCA) and distal CCA (dCCA), accounting for about 5% to 10%, 60% to 70%, and 20% to 30% of all CCA cases, respectively [2, 3]. Given their differences in frequency, pathobiology, management and prognosis, iCCA, pCCA and dCCA should be viewed as separate entities, and surgery is the only curative treatment for a long-term survival [4]. Intraoperative frozen section (FS) is broadly used during pancreaticoduodenectomy (PD) to ensure a negative margin status, but its survival benefits on obtaining a secondary R0 resection for distal cholangiocarcinoma (dCCA) is controversial and unclear
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