• Circumferential margin
• Perihilar cholangiocarcinoma
• Radial margin
• Resection margin
• Survival outcomes

• Humans
• Margins of Excision
• Female
• Klatskin Tumor/surgery
• Klatskin Tumor/pathology
• Klatskin Tumor/mortality
• Male
• Bile Duct Neoplasms/surgery
• Bile Duct Neoplasms/pathology
• Bile Duct Neoplasms/mortality
• Middle Aged
• Retrospective Studies
• Aged
• Adult
• Neoplasm Staging
• Survival Rate
• Hepatectomy/methods
• Prognosis
• Aged, 80 and over

• benign lesion
• dilated common bile duct
• extrahepatic cholangiocarcinoma
• extrahepatic cholestasis
• hepato-pancreato-biliary surgery

• Biliary intraepithelial neoplasia
• Intraoperative frozen pathology
• Perihilar Cholangiocarcinoma
• Surgical resection

• Humans
• Male
• Female
• Bile Duct Neoplasms/surgery
• Bile Duct Neoplasms/pathology
• Bile Duct Neoplasms/mortality
• Margins of Excision
• Retrospective Studies
• Klatskin Tumor/surgery
• Klatskin Tumor/pathology
• Klatskin Tumor/mortality
• Middle Aged
• Aged
• Prognosis
• Follow-Up Studies
• Survival Rate
• Carcinoma in Situ/surgery
• Carcinoma in Situ/pathology
• Neoplasm, Residual/pathology
• Neoplasm, Residual/surgery
• Adult
• Cell Transformation, Neoplastic/pathology
• Neoplasm Recurrence, Local/pathology
• Neoplasm Recurrence, Local/surgery
• Neoplasm Recurrence, Local/epidemiology
• Hepatectomy/methods
• Hepatectomy/mortality
• Aged, 80 and over

• XZ-2019-505-070 the Talent Training Plan of Army Medical University
• XZ-2019-505-070 the Talent Training Plan of Army Medical University
• CSTC2021jscx-gksb-N0009 Chongqing Technology Innovation and Application Development Special Key Project
• CSTC2021jscx-gksb-N0009 Chongqing Technology Innovation and Application Development Special Key Project

• Bile duct cancer
• Extrahepatic
• Guidlines

• Frozen section
• Perihilar cholangiocarcinoma
• Proximal margin positivity
• Resection of proximal margins

• Adjuvant chemotherapy
• Adjuvant radiation
• Adjuvant treatment
• Chemoradiation
• Cholangiocarcinoma
• Perihilar cholangiocarcinoma

• Curative-intent resection
• Early recurrence
• Perihilar cholangiocarcinoma
• Prognostic factors
• meta-Analysis

• Humans
• Klatskin Tumor/surgery
• Klatskin Tumor/pathology
• Prognosis
• Treatment Outcome
• Bile Duct Neoplasms/surgery
• Bile Duct Neoplasms/pathology
• Hepatectomy
• Cholangiocarcinoma/surgery
• Cholangiocarcinoma/pathology

• biliary tract neoplasm
• perihilar cholangiocarcinoma
• preoperative treatment
• treatment strategy

• Diagnostic accuracy
• Errors
• Frozen sections
• Hepato-pancreato-biliary
• Indications
• Surgeries

• Humans
• Frozen Sections/methods
• Retrospective Studies
• Pathology, Surgical
• Neoplasms
• Predictive Value of Tests

• Humans
• Klatskin Tumor/pathology
• Retrospective Studies
• Prognosis
• Cholangiocarcinoma
• Bile Ducts, Intrahepatic/pathology
• Hepatectomy
• Bile Duct Neoplasms
• Margins of Excision
• Survival Rate

• Chemoimmunotherapy
• Chemotherapy
• High-risk patients
• Perihilar cholangiocarcinoma
• Postoperative adjuvant therapy

• Additional resections
• Intraoperative frozen sections
• Overall survival
• Perihilar cholangiocarcinoma
• Surgery

• adjuvant treatment strategy
• biliary tract cancer
• cholangiocarcinoma
• intra-operative re-operation
• margin status
• nodal status

• artificial intelligence
• liver transplantation
• minimally invasive surgery
• neoadjuvant therapy
• perihilar cholangiocarcinoma

The only potentially curative treatment of perihilar cholangiocarcinoma (PHC) is complete (R0) resection. This is difficult to achieve and great effort should be made to optimise surgical margins assessment and to thoroughly define their prognostic value. When considering resections for PHC, not only bile duct margins (ductal margins, DM), but also the liver transection plane and the dissection plane in the hepatoduodenal ligament (radial margins, RM) should be examined. Studies concerning PHC resections with comprehensive analyses of the recurrence and survival related to margins status most frequently consider only ductal margins. The importance of also assessing radial margins’ prognostic value was recently introduced and deserves to be further studied. To our knowledge, there is currently no evidence of prognostic value of isolated positive RM. Therefore, the aim of this study was to evaluate the incidence and to investigate the effects on the recurrence and survival of positive isolated RM in resected PHC.

In resected perihilar cholangiocarcinoma (PHC), positive ductal margin (DM) is associated with poor survival. There is currently little knowledge about the impact of positive radial margin (RM) when DM is negative. The aim of this study was to evaluate the incidence and the role of positive RM. Patients who underwent surgery between 2005 and 2017 where retrospectively reviewed and stratified according to margin positivity: an isolated RM-positive group and DM ± RM group. Of the 75 patients identified; 34 (45.3%) had R1 resection and 17 had positive RM alone. Survival was poorer in patients with R1 resection compared to R0 (p = 0.019). After stratification according to margin positivity; R0 patients showed better survival than DM ± RM-positive patients (p = 0.004; MST 43.9 vs. 23.6 months), but comparable to RM-positive patients (p = 0.361; MST 43.9 vs. 39.5 months). Recurrence was higher in DM ± RM group compared to R0 (p = 0.0017; median disease-free survival (DFS) 15 vs. 30 months); but comparable between RM and R0 group (p = 0.39; DFS 20 vs. 30 months). In univariate and multivariate analysis, DM positivity resulted as a negative prognostic factor both for survival and recurrence. In conclusion, positive RM resections appear to have different recurrence patterns and survival rates than positive DM resections.

• Cholangiocarcinoma
• Genetic aberration
• Immunotherapy
• Liver resection
• Liver transplantation
• Treatment

• Bismuth I
• Bismuth II
• Cholangiocarcinoma
• Hilar
• Outcomes
• Resection

• Bile Duct Neoplasms/surgery
• Bile Ducts
• Cholangiocarcinoma/surgery
• Hepatectomy
• Humans
• Klatskin Tumor/surgery
• Neoplasm Staging
• Retrospective Studies
• Treatment Outcome

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.

Clinical 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.

There 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.

Intraoperative 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.

• distal cholangiocarcinoma
• frozen section
• pancreatoduodenectomy
• resection margin
• survival analysis

• Hilar cholangiocarcinoma
• Left-side hepatectomy
• Meta-analysis
• Perihilar cholangiocarcinoma
• Right-side hepatectomy

• Bile Duct Neoplasms/surgery
• Bile Ducts, Intrahepatic/surgery
• Cholangiocarcinoma/surgery
• Hepatectomy/adverse effects
• Humans
• Klatskin Tumor/surgery
• Prognosis
• Retrospective Studies
• Treatment Outcome

• No.81874228 National Natural Science Foundation of China
• JBZX-202004 Grant from Health Commission of Zhejiang Province

• Bile duct segmental resection
• Common bile duct cancer
• Cutoff value
• Survival

• Case report
• Cystic liver lesion
• Diagnosis
• Intraductal papillary neoplasm of the bile duct
• Liver resection
• Management

• Perihilar cholangiocarcinoma
• Radical resection
• Surgical therapy
• Survival
• Vascular reconstruction

• Biliary Tract Neoplasms/diagnosis
• Biliary Tract Neoplasms/epidemiology
• Biliary Tract Neoplasms/etiology
• Biliary Tract Neoplasms/surgery
• Biliary Tract Surgical Procedures/methods
• Digestive System Diseases/diagnosis
• Digestive System Diseases/epidemiology
• Digestive System Diseases/etiology
• Digestive System Diseases/surgery
• Humans

• P30 CA008748 NCI NIH HHS

• Liver transplantation
• Neoadjuvant therapy
• Perihilar cholangiocarcinoma

• high grade biliary intraepithelial neoplasia
• margins of excision
• perihilar cholangiocarcinoma
• recurrence
• survival

Intraductal papillary neoplasm of the bile duct (IPNB) is characterized by an intraluminal, growing papillary tumor covered by neoplastic biliary epithelial cells with a fine fibrovascular core. IPNB was introduced as a precancerous and early neoplastic lesion in the 2010 World Health Organization classification of tumors of the digestive system. IPNB eventually invades the bile duct wall and progresses to invasive cholangiocarcinoma. IPNB resembles intraductal papillary mucinous neoplasm of the pancreas (IPMN), particularly the main pancreatic duct type.

IPNB cases, possibly corresponding to branch-type IPMN, have been recently reported, and these cases involved the peribiliary glands significantly and showed gross cystic dilatation. Small branch-type intrahepatic IPNB often mimics simple liver cysts, making the diagnosis of IPNB difficult. Some literature recommended surgical resection for treatment. Laparoscopic resection is a good treatment option for small tumor. We herein present the case of branch-type IPNB that was treated with laparoscopic anatomical liver resection 5 years after being detected.

A 64-year-old woman was undergoing follow-up for primary aldosteronism. In 2012, follow-up computed tomography (CT) incidentally revealed a 7-mm cystic lesion in segment 8 of the liver. From 2012 to 2017, the cystic lesion kept increasing in size, reaching 17 mm. In 2017, CT also revealed a 13-mm mural nodule in the cyst wall. Therefore, the patient was referred to our department for possible malignancy.

We suspected a branch-type IPNB; however, the mass was small and diagnosis could not be made without performing biopsy. Accordingly, surgical resection was performed for diagnosis and treatment. Because branch-type IPNB might show horizontal spread through the intrahepatic bile duct, we believed that anatomical resection of the liver was appropriate considering the malignant potential of the lesion. Therefore, laparoscopic anatomical resection of segment 8 of the liver was performed. The resected tumor measured 17 mm and was histologically diagnosed as a high-grade IPNB.

Branch-type IPNBs are rare but can potentially lead to malignant tumors. Surgical resection is the treatment of choice, with laparoscopic anatomical resection being a good treatment option for this small tumor.

• Intraductal papillary mucinous neoplasm of the pancreas
• Intraductal papillary neoplasm of the bile duct
• Laparoscopic anatomical resection
• Segmentectomy
• Surgical margin

The incidence of a positive microscopic ductal margin (R1) after surgical resection for perihilar cholangiocarcinoma (pCCA) remains high, but the beneficial of additional resection has not been confirmed by any meta-analysis and randomized clinical trials (RCT), which also increased the risk of morbidity and mortality. Hence, a systematic review is warranted to evaluate the clinical value of additional resection of intraoperative R1 for pCCA.

Eligible studies were searched by PubMed, MedLine, Embase, the Cochrane Library, Web of Science, from Jan.1^st 2000 to Nov.30^th 2019, evaluating the 1-, 3-, and 5-year overall survival (OS) rates of additional resection of intraoperative pathologic R1 for pCCA. Odds ratio (OR) with 95% confidence interval (CI) was used to determine the effect size by a randomized-effect model.

Eight studies were enrolled in this meta-analysis, including 179 patients in the secondary R0 group, 843 patients in the primary R0 group and 253 patients in the R1 group. The pooled OR for the 1-, 3-, and 5-year OS rate between secondary R0 group and primary R0 group were 1.03(95%CI 0.64~1.67, P = 0.90), 0.92(95%CI 0.52~1.64, P = 0.78), and 0.83(95%CI 0.37~1.84, P = 0.65), respectively. The pooled OR for the 1-, 3-, and 5-year OS rate between secondary R0 group and R1 group were 2.14(95%CI 1.31~3.50, P = 0.002), 2.58(95%CI 1.28~5.21, P = 0.008), and 3.54(95%CI 1.67~7.50, P = 0.001), respectively. However, subgroup analysis of the West showed that the pooled OR for the 1-, and 3-year OS rate between secondary R0 group and R1 group were 2.05(95%CI 0.95~4.41, P = 0.07), 1.91(95%CI 0.96~3.81, P = 0.07), respectively.

With the current data, additional resection should be recommended in selected patients with intraoperative R1, but the conclusion is needed further validation.

• Bile Duct Neoplasms/surgery
• Humans
• Klatskin Tumor/surgery
• Margins of Excision
• Neoplasm Recurrence, Local
• Prognosis

• Startup Fund for scientific research, Fujian Medical University

• Bismuth-Corlette classification
• Early recurrence
• Hilar cholangiocarcinoma
• Lymphocyte to monocyte ratio
• Resectability

• cholangiocarcinoma
• preoperative preparation
• surgery

High-grade dysplasia/carcinoma in situ (HGD/CIS) of the biliary duct margin was found to not affect the prognosis of patients with extrahepatic cholangiocarcinoma by recent studies, but it has not yet reached a conclusion.

Eligible studies were searched by PubMed, PMC, MedLine, Embase, the Cochrane Library, and Web of Science, from Jan. 1, 2000 to Jun. 30, 2019, investigating the influences of surgical margin status of biliary duct on the prognosis of patients with resectable extrahepatic cholangiocarcinoma. Overall survival (OS) and local recurrence were evaluated by odds ratio (OR) with 95% confidence interval (CI).

A total of 11 studies were enrolled in this meta-analysis, including 1734 patients in the R0 group, 194 patients in the HGD/CIS group, and 229 patients in the invasive carcinoma (INV) group. The pooled OR for the 1-, 2-, and 3-year OS rate between HGD/CIS group and R0 group was 0.98 (95% CI 0.65~1.50), 1.01 (95% CI 0.73~1.41), and 0.98 (95% CI 0.72~1.34), respectively. The pooled OR for the 1-, 2-, and 3-year OS rate between HGD/CIS group and INV group was 1.83 (95% CI 1.09~3.06), 4.52 (95% CI 2.20~9.26), and 3.74 (95% CI 2.34~5.96), respectively. Subgroup analysis of extrahepatic cholangiocarcinoma at early stage showed that the pooled OR for the 1-, 2-, and 3-year OS rate between HGD/CIS group and R0 group was 0.54 (95% CI 0.21~1.36), 0.75 (95% CI 0.35~1.58), and 0.74 (95% CI 0.40~1.37), respectively, and the pooled OR for the 1-, 2-, and 3-year OS rate between HGD/CIS group and INV group was 3.47 (95% CI 1.09~11.02), 9.12 (95% CI 2.98~27.93), and 9.17 (95% CI 2.95~28.55), respectively. However, the pooled OR for the incidence of local recurrence between HGD/CIS group and R0 group was 3.54 (95% CI 1.66~7.53), and the pooled OR for the incidence of local recurrence between HGD/CIS group and INV group was 0.93 (95% CI 0.50~1.74).

With the current data, we concluded that HGD/CIS would increase the risk of local recurrence compared with R0, although it did not affect the prognosis of patients with extrahepatic cholangiocarcinoma regardless of TNM stage. However, the conclusion needs to be furtherly confirmed.

• Carcinoma in situ
• Extrahepatic cholangiocarcinoma
• High-grade dysplasia
• Meta-analysis
• Prognosis

• Cholangiocarcinoma
• chemoradiation
• chemotherapy
• hilar
• intrahepatic
• perihilar
• radiation therapy
• surgery

• Hepatic resection
• Hilar cholangiocarcinoma
• Liver transplantation
• Vascular resection

Early recurrence has been reported to be predictive of a poor prognosis for patients with perihilar cholangiocarcinoma (pCCA) after resection. The objective of our study was to construct a useful scoring system to predict early recurrence for Bismuth–Corlette type IV pCCA patients in clinic and to investigate the value of early recurrence in directing post-operative surveillance and adjuvant therapy.

In total, 244 patients who underwent radical resection for type IV pCCA were included. Data on clinicopathological characteristics, perioperative details and survival outcomes were analyzed. Survival curves were generated using the Kaplan–Meier method. Univariate and multivariate logistic-regression models were used to identify factors associated with early recurrence.

Twenty-one months was defined as the cutoff point to distinguish between early and late recurrence. Univariate and multivariate analysis revealed that CA19-9 level >200 U/mL, R1 resection margin, higher N category and positive lymphovascular invasion were independent predictors of early recurrence. The scoring system was constructed accordingly. The early-recurrence rates of patients with scores of 0, 1, 2, 3, 4, and 5 were 23.9%, 38.7%, 60.0%, 78.6%, 83.4%, and 100%, respectively. Adjuvant therapy was significantly associated with higher overall survival rate for patients with early recurrence, but not for those with late recurrence. Patients in the early-recurrence group with scores ≥2 had better prognoses after adjuvant therapy.

A simple scoring system using CA19-9 level, N category, resection margin and lymphovascular invasion status could predict early recurrence, and thus might direct post-operative surveillance and adjuvant therapy for patients with type IV pCCA.

• Bismuth–Corlette classification
• early recurrence
• perihilar cholangiocarcinoma

• additional resection
• bile duct neoplasm
• carcinoma in situ
• cholangiocarcinoma
• ductal resection margin status