Impact of residual in situ carcinoma on postoperative survival in 125 patients with extrahepatic bile duct carcinoma

PURPOSE: The aim of this study was to determine the impact of the presence of carcinoma in situ at the bile duct stump on postoperative survival in patients who underwent resection of extrahepatic bile duct carcinoma. METHODS: The patients with resected extrahepatic bile duct carcinoma were divided into three groups according to resected margin status: no evidence of residual carcinoma (Negative group, n = 96); carcinoma in situ at the bile duct stump (CIS group, n = 10); and invasive carcinoma at any surgical margin (Invasive group, n = 19). Cause-specific survival for these groups was compared statistically. RESULTS: Surgical margin status was identified as a prognostic factor on univariate analysis (p = 0.005) and was an independent prognostic factor on multivariate analysis (p = 0.018). The CIS group displayed significantly better survival than the Invasive group (p = 0.006), and the survival was comparable to that for the Negative group (p = 0.533). Two of three patients in the CIS group with local recurrence died >5 years after surgical resection. CONCLUSIONS: Patients with positive ductal margins of carcinoma in situ of the extrahepatic bile duct do not appear to show different survival after resection compared to patients with negative margins, but remnant carcinoma in situ is likely to develop late local recurrence.