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A novel method for predicting perineural invasion of distal cholangiocarcinoma on multidetector-row computed tomography

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Abstract

Purpose

Excessive perineural invasion (PNI) is associated with a high risk of radial margin (RM) positivity and a poor prognosis for patients with distal cholangiocarcinoma (DCC). This study evaluates a new method of predicting the extent of PNI preoperatively.

Methods

The subjects of this retrospective study were 201 patients who underwent resection for DCC between 2002 and 2018. This study identified the ‘periductal enation sign’ (PES), defined as the surrounding soft tissue enhancement that appears as an enation from the circumference of the enhanced extrahepatic bile duct on multidetector-row computed tomography (MDCT) scans, as a predictor of PNI. We analyzed the outcomes of the patients in relation to the presence or absence of the PES on MDCT scans.

Results

The PES in the PNI-positive group was significantly longer than that in the PNI-negative group. As the length of the PES extended, the grade of PNI increased. A positive PES was defined as a PES length of ≥ 2.0 mm. Patients with a positive PES were more frequently positive for RM (23.7% vs. 2.1%) and locoregional recurrence (23.7% vs. 6.3%) and exhibited significantly poorer overall survival than those with a negative PES (30.2% vs. 54.6% at 5 years).

Conclusions

The presence and extent of PNI can be predicted easily and effectively by the PES length. A positive PES was associated with poor local controllability and a poor prognosis.

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References

  1. DeOliveira ML, Cunningham SC, Cameron JL, Kamangar F, Winter JM, Lillemoe KD, et al. Cholangiocarcinoma: thirty-one-year experience with 564 patients at a single institution. Ann Surg. 2007;245:755–62.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Komaya K, Ebata T, Shirai K, Ohira S, Morofuji N, Akutagawa A, et al. Recurrence after resection with curative intent for distal cholangiocarcinoma. Br J Surg. 2017;104:426–33.

    Article  CAS  PubMed  Google Scholar 

  3. Ebata T, Yokoyama Y, Igami T, Sugawara G, Takahashi Y, Nimura Y, et al. Hepatopancreatoduodenectomy for cholangiocarcinoma: a single-center review of 85 consecutive patients. Ann Surg. 2012;256:297–305.

    Article  PubMed  Google Scholar 

  4. Aoki T, Sakamoto Y, Kohno Y, Akamatsu N, Kaneko J, Sugawara Y, et al. Hepatopancreaticoduodenectomy for biliary cancer: strategies for near-zero operative mortality and acceptable long-term outcome. Ann Surg. 2018;267:332–7.

    Article  PubMed  Google Scholar 

  5. Bhuiya MR, Nimura Y, Kamiya J, Kondo S, Fukata S, Hayakawa N, et al. Clinicopathologic studies on perineural invasion of bile duct carcinoma. Ann Surg. 1992;215:344–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Maxwell P, Hamilton PW, Sloan JM. Three-dimensional reconstruction of perineural invasion in carcinoma of the extrahepatic bile ducts. J Pathol. 1996;180:142–5.

    Article  CAS  PubMed  Google Scholar 

  7. Kayahara M, Nagakawa T, Ohta T, Kitagawa H, Tajima H, Miwa K. Role of nodal involvement and the periductal soft-tissue margin in middle and distal bile duct cancer. Ann Surg. 1999;229:76–83.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Sakamoto Y, Kosuge T, Shimada K, Sano T, Ojima H, Yamamoto J, et al. Prognostic factors of surgical resection in middle and distal bile duct cancer: an analysis of 55 patients concerning the significance of ductal and radial margins. Surgery. 2005;137:396–402.

    Article  PubMed  Google Scholar 

  9. Wellner UF, Shen Y, Keck T, Jin W, Xu Z. The survival outcome and prognostic factors for distal cholangiocarcinoma following surgical resection: a meta-analysis for the 5-year survival. Surg Today. 2017;47:271–9.

    Article  CAS  PubMed  Google Scholar 

  10. Kaneoka Y, Maeda A, Isogai M. En bloc resection of the hepatoduodenal ligament for advanced biliary malignancy. J Gastrointest Surg. 2015;19:708–14.

    Article  PubMed  Google Scholar 

  11. Miura F, Sano K, Amano H, Toyota N, Wada K, Yoshida M, et al. Evaluation of portal vein invasion of distal cholangiocarcinoma as borderline resectability. J Hepatobiliary Pancreat Sci. 2015;22:294–300.

    Article  PubMed  Google Scholar 

  12. Maeta T, Ebata T, Hayashi E, Kawahara T, Mizuno S, Matsumoto N, et al. Pancreatoduodenectomy with portal vein resection for distal cholangiocarcinoma. Br J Surg. 2017;104:1549–57.

    Article  CAS  PubMed  Google Scholar 

  13. Fukuda T, Iwanaga S, Sakamoto I, Aso N, Nagaoki K, Hayashi K, et al. CT of neural plexus invasion in common bile duct carcinoma. J Comput Assist Tomogr. 1998;22:351–6.

    Article  CAS  PubMed  Google Scholar 

  14. Tian H, Mori H, Matsumoto S, Yamada Y, Kiyosue H, Ohta M, et al. Extrapancreatic neural plexus invasion by carcinomas of the pancreatic head region: evaluation using thin-section helical CT. Radiat Med. 2007;25:141–7.

    Article  PubMed  Google Scholar 

  15. Yamada Y, Mori H, Hijiya N, Matsumoto S, Takaji R, Kiyonaga M, et al. Extrahepatic bile duct cancer: invasion of the posterior hepatic plexuses–evaluation using multidetector CT. Radiology. 2012;263:419–28.

    Article  PubMed  Google Scholar 

  16. Li J, Wang L, Li L, Qiao J, Zheng Z. Preliminary study of perineural invasion in patients with hilar cholangiocarcinoma by computed tomography imaging. Clin Imaging. 2020;61:49–53.

    Article  PubMed  Google Scholar 

  17. Sobin LH, Gospodarowicz MK, Wittekind C. International Union Against Cancer (UICC) TNM Classification of Malignant Tumours. 7th ed. New York: Wiley-Liss; 2010.

    Google Scholar 

  18. Miyazaki M, Ohtsuka M, Miyakawa S, Nagino M, Yamamoto M, Kokudo N, et al. Classification of biliary tract cancers established by the Japanese Society of Hepato-Biliary-Pancreatic Surgery: 3(rd) English edition. J Hepatobil Pancreat Sci. 2015;22:181–96.

  19. Yamamoto Y, Ashida R, Ohgi K, Sugiura T, Okamura Y, Ito T, et al. Combined antrectomy reduces the incidence of delayed gastric emptying after pancreatoduodenectomy. Dig Surg. 2018;35:121–30.

    Article  PubMed  Google Scholar 

  20. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Park Y, Hwang DW, Kim JH, Hong SM, Jun SY, Lee JH, et al. Prognostic comparison of the longitudinal margin status in distal bile duct cancer: R0 on first bile duct resection versus R0 after additional resection. J Hepatobil Pancreat Sci. 2019;26:169–78.

    Article  Google Scholar 

  22. Ke Q, Wang B, Lin N, Wang L, Liu J. Does high-grade dysplasia/carcinoma in situ of the biliary duct margin affect the prognosis of extrahepatic cholangiocarcinoma? A meta-analysis. World J Surg Oncol. 2019;17:211.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Ebata T, Hirano S, Konishi M, Uesaka K, Tsuchiya Y, Ohtsuka M, et al. Randomized clinical trial of adjuvant gemcitabine chemotherapy versus observation in resected bile duct cancer. Br J Surg. 2018;105:192–202.

    Article  CAS  PubMed  Google Scholar 

  24. Sugiura T, Uesaka K, Okamura Y, Ito T, Yamamoto Y, Ashida R, et al. Adjuvant chemoradiotherapy for positive hepatic ductal margin on cholangiocarcinoma. Ann Gastroenterol Surg. 2020;4:455–63.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Varadhachary GR, Tamm EP, Abbruzzese JL, Xiong HQ, Crane CH, Wang H, et al. Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy. Ann Surg Oncol. 2006;13:1035–46.

    Article  PubMed  Google Scholar 

  26. National Comprehensive Cancer Network. NCCN practice guidelines for pancreatic adenocarcinoma, Version 2.2021 https://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf. 2021.

  27. Primrose JN, Fox RP, Palmer DH, Malik HZ, Prasad R, Mirza D, et al. Capecitabine compared with observation in resected biliary tract cancer (BILCAP): a randomised, controlled, multicentre, phase 3 study. Lancet Oncol. 2019;20:663–73.

    Article  CAS  PubMed  Google Scholar 

  28. Seita K, Ebata T, Mizuno T, Maeda A, Yamaguchi R, Kurumiya Y, et al. Phase 2 trial of adjuvant chemotherapy with S - 1 for node-positive biliary tract cancer (N-SOG 09). Ann Surg Oncol. 2020;27:2348–56.

    Article  PubMed  Google Scholar 

  29. Takahashi D, Mizuno T, Yokoyama Y, Igami T, Yamaguchi J, Onoe S, et al. Adjuvant S-1 versus gemcitabine for node-positive perihilar cholangiocarcinoma: a propensity score-adjusted analysis. J Hepatobiliary Pancreat Sci. 2021. https://doi.org/10.1002/jhbp.1005.

    Article  PubMed  Google Scholar 

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Acknowledgements

We have no competing interests and no funding to declare.

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Authors and Affiliations

  1. Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan

    Ryusei Yamamoto, Teiichi Sugiura, Yukiyasu Okamura, Ryo Ashida, Katsuhisa Ohgi, Mihoko Yamada, Shimpei Otsuka & Katsuhiko Uesaka

  2. Division of Diagnostic Radiology, Shizuoka Cancer Center, Shizuoka, Japan

    Takeshi Aramaki & Koiku Asakura

Authors
  1. Ryusei Yamamoto
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  2. Teiichi Sugiura
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Correspondence to Teiichi Sugiura.

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Yamamoto, R., Sugiura, T., Okamura, Y. et al. A novel method for predicting perineural invasion of distal cholangiocarcinoma on multidetector-row computed tomography. Surg Today 52, 774–782 (2022). https://doi.org/10.1007/s00595-021-02405-3

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  • DOI: https://doi.org/10.1007/s00595-021-02405-3

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