OBJECTIVE: To review our experience with cholangiocarcinoma with superficial spread, to clarify its clinical features, and to discuss treatment strategies. SUMMARY BACKGROUND DATA: Most of the previous reports on cholangiocarcinoma with superficial spread were case reports. Little is known about this type of cholangiocarcinoma. METHODS: The medical records of 471 patients with cholangiocarcinoma who underwent resection (351 perihilar and 120 distal cancers) were retrospectively reviewed, focusing on superficial spread, which was defined as noninvasive cancer extension of more than 20 mm. RESULTS: Superficial spread was found in 69 (14.6%) of 471 patients, and its length was 54 +/- 19 mm. Histologically, papillary and well differentiated adenocarcinomas were observed more frequently in cholangiocarcinomas with superficial spread (C(+SS)), compared with those without superficial spread (C(-SS)). Histologic indexes showing tumor aggressiveness, including lymphatic, venous, and perineural invasions, were lower in C(+SS), and all factors of tumor staging (pT, pN, and pM) were less advanced in C(+SS) than in C(-SS). Regarding surgical procedure, a combined hepatectomy and pancreatoduodenectomy was indicated in 26 (37.7%) of the 69 patients with C(+SS), but in only 25 (6.2%) of the 402 patients with C(-SS). Positivity of the proximal ductal margin was higher in C(+SS) than in C(-SS) (18.8% vs. 11.9%), although this was not statistically significant. All positive proximal ductal margins in C(+SS) were because of carcinoma in situ, whereas invasive cancer was the main reason for positivity in C(-SS). Survival (excluding 29 in-hospital deaths) was significantly better in the patients with C(+SS) than in those with C(-SS) (5- and 10-year survival rates; 48.8% and 19.6% vs. 26.8% and 16.6%, P = 0.0009). Survival was comparable between the patients with a negative ductal margin and those with a positive margin with carcinoma in situ. On multivariate analysis, the presence or absence of superficial spread was not identified as a prognostic factor. CONCLUSIONS: C(+SS) is associated with less advanced, slower growing tumors and better survival compared with C(-SS). In many cases of C(+SS), the survival does not depend on the complete resection of all the superficial spread but on the stage of the main lesion.
OBJECTIVE: To review our experience with cholangiocarcinoma with superficial spread, to clarify its clinical features, and to discuss treatment strategies. SUMMARY BACKGROUND DATA: Most of the previous reports on cholangiocarcinoma with superficial spread were case reports. Little is known about this type of cholangiocarcinoma. METHODS: The medical records of 471 patients with cholangiocarcinoma who underwent resection (351 perihilar and 120 distal cancers) were retrospectively reviewed, focusing on superficial spread, which was defined as noninvasive cancer extension of more than 20 mm. RESULTS: Superficial spread was found in 69 (14.6%) of 471 patients, and its length was 54 +/- 19 mm. Histologically, papillary and well differentiated adenocarcinomas were observed more frequently in cholangiocarcinomas with superficial spread (C(+SS)), compared with those without superficial spread (C(-SS)). Histologic indexes showing tumor aggressiveness, including lymphatic, venous, and perineural invasions, were lower in C(+SS), and all factors of tumor staging (pT, pN, and pM) were less advanced in C(+SS) than in C(-SS). Regarding surgical procedure, a combined hepatectomy and pancreatoduodenectomy was indicated in 26 (37.7%) of the 69 patients with C(+SS), but in only 25 (6.2%) of the 402 patients with C(-SS). Positivity of the proximal ductal margin was higher in C(+SS) than in C(-SS) (18.8% vs. 11.9%), although this was not statistically significant. All positive proximal ductal margins in C(+SS) were because of carcinoma in situ, whereas invasive cancer was the main reason for positivity in C(-SS). Survival (excluding 29 in-hospital deaths) was significantly better in the patients with C(+SS) than in those with C(-SS) (5- and 10-year survival rates; 48.8% and 19.6% vs. 26.8% and 16.6%, P = 0.0009). Survival was comparable between the patients with a negative ductal margin and those with a positive margin with carcinoma in situ. On multivariate analysis, the presence or absence of superficial spread was not identified as a prognostic factor. CONCLUSIONS: C(+SS) is associated with less advanced, slower growing tumors and better survival compared with C(-SS). In many cases of C(+SS), the survival does not depend on the complete resection of all the superficial spread but on the stage of the main lesion.