gms | German Medical Science

131. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

25.03. - 28.03.2014, Berlin

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

Meeting Abstract

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

Deutsche Gesellschaft für Chirurgie. 131. Kongress der Deutschen Gesellschaft für Chirurgie. Berlin, 25.-28.03.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. Doc14dgch048

doi: 10.3205/14dgch048, urn:nbn:de:0183-14dgch0488

Published: March 21, 2014

© 2014 Matthaei et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Introduction: Biliary tract cancers (BTCs) are highly aggressive malignant tumors arising from the biliary ductal epithelium that are diagnosed with increasing incidence. They include intrahepatic, perihilar and extrahepatic cholangiocarcinomas (CC) as well as gallbladder carcinomas. Tumor resection with cancer-free margins (R0) is crucial for curative therapy. However, the prevalence, possible clinical impact as well as therapeutic implication of biliary intraepithelial neoplasia (BilIN) as non-invasive precursor lesion of BTC at margin is largely unknown.

Material and methods: A retrospective study of patients who underwent resection for BTC between 1990 and 2012 was performed. Patients in whom a meticulous reanalysis of their resection margins was feasible were included. Herein, we assessed the presence or absence and grade of BilIN. Data was correlated to clinicopathologic parameters and to overall survival.

Results: BilINs were detected in 31 of 60 patients (52%) and were most prevalent in the margins of resected perihilar CCs (N=7 of 9; 78%). With respect to epithelial dysplasia most lesions were categorized as BilIN-1 (N=15 of 31; 48%). The presence of BilIN at margin significantly correlated with size of the primary tumor (T3+4 vs. T1+2: p=0.004), a positive resection margin (R1 vs. R0: p=0.03), lymphovascular (L1 vs. L0: p=0.005), and perineural invasion (P1 vs. P0: p=0.08). Patients with positive margins (R1) had a significant shorter overall survival as compared to R0-resected patients irrespective of BilIN at margin (R1 vs. R0: p=0.02). Importantly, neither BilIN-presence nor BilIN-grade correlated with overall survival in R0-resected patients. Figure 1 [Fig. 1]

Conclusion: BilINs are frequently found in margins of resected BTCs. Therefore, hepatopancreatobiliary surgeons should be aware of being confronted with this only recently defined entity during intraoperative frozen sectioning. Though, no impact on overall survival was observed even if a margin displayed BilIN-3 aka carcinoma in situ. Thus, 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.