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.