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132. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

28.04. - 01.05.2015, München

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Prevalence and clinical impact of biliary intraepithelial neoplasia (BilIN) in the surgical margins of resected biliary tract cancers

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  • Hanno Matthaei - Universitätsklinikum Bonn, Klinik und Poliklinik für Allgemein-; Viszeral-, Thorax- und Gefäßchirurgie, Bonn, Deutschland
  • Philipp Lingohr - Universitätsklinikum Bonn, Klinik und Poliklinik für Allgemein-; Viszeral-, Thorax- und Gefäßchirurgie, Bonn, Deutschland
  • Anke Strässer - Universitätsklinikum Bonn, Institut für Pathologie, Bonn, Deutschland
  • Dimo Dietrich - Universitätsklinikum Bonn, Institut für Pathologie, Bonn, Deutschland
  • Babak Rostamzadeh - Universitätsklinikum Bonn, Institut für Pathologie, Bonn, Deutschland
  • Martin Roering - Universitätsklinikum Bonn, Klinik und Poliklinik für Allgemein-; Viszeral-, Thorax- und Gefäßchirurgie, Bonn, Deutschland
  • Pauline Möhring - Universitätsklinikum Bonn, Klinik und Poliklinik für Allgemein-; Viszeral-, Thorax- und Gefäßchirurgie, Bonn, Deutschland
  • Burkhard Stoffels - Universitätsklinikum Bonn, Klinik und Poliklinik für Allgemein-; Viszeral-, Thorax- und Gefäßchirurgie, Bonn, Deutschland
  • Jörg C. Kalff - Universitätsklinikum Bonn, Klinik und Poliklinik für Allgemein-; Viszeral-, Thorax- und Gefäßchirurgie, Bonn, Deutschland
  • Nico Schäfer - Universitätsklinikum Bonn, Klinik und Poliklinik für Allgemein-; Viszeral-, Thorax- und Gefäßchirurgie, Bonn, Deutschland
  • Glen Kristiansen - Universitätsklinikum Bonn, Institut für Pathologie, Bonn, Deutschland

Deutsche Gesellschaft für Chirurgie. 132. Kongress der Deutschen Gesellschaft für Chirurgie. München, 28.04.-01.05.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. Doc15dgch060

doi: 10.3205/15dgch060, urn:nbn:de:0183-15dgch0604

Published: April 24, 2015

© 2015 Matthaei et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Introduction: Biliary tract cancers (BTCs) are aggressive tumors diagnosed with increasing incidence. Resection with cancer-free margins is crucial for curative therapy. However, the prevalence, possible clinical impact and therapeutic implication of biliary intraepithelial neoplasia (BilIN) as direct precursor lesions of BTC at final margin is largely unknown.

Material and methods: We reanalyzed final resection margins of patients who underwent resection for adenocarcinomas of the biliary tree including the gallbladder for presence or absence and, if positive, grade of BilIN. Data was correlated to clinicopathologic parameters and overall survival.

Results: A complete margin analysis was possible in 55 of 78 patients (71%). BilINs were detected in 29 patients (53%), were most prevalent after resection for extrahepatic cholangiocarcinoma (N=6 of 8; 75%) and showed mainly low-grade dysplasia (BilIN-1; N=14 of 29; 48%). Presence of BilIN at margin correlated with tumor location (P=0.007), large primary (P=0.001), lymphovascular (P=0.006), and perineural invasion (P=0.049). Patients with cancer at margin (R1) had a significantly shorter overall survival compared to R0-resected patients irrespective of BilIN (R0 vs. R1; P<0.001). Neither presence nor grade of BilIN at margin correlated with overall survival in curatively resected patients (BilIN pos. vs. BilIN neg.: P=0.6 and BilIN-1 2 vs. BilIN-3: P= 0.58). Figure 1 [Fig. 1]

Conclusion: BilINs are frequently found in margins of resected adenocarcinomas of the biliary tract. Thus, hepatopancreatobiliary surgeons should be aware of being confronted with this recently defined entity during intraoperative frozen sectioning. Though, no additional resection seems justified in this situation and pathologists should continue to focus on the detection of invasive tumor remnants in the evaluation of margins in intraoperative frozen sections.