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Pancreatic and Duodenal Invasion in Distal Bile Duct Cancer: Paradox in the Tumor Classification of the American Joint Committee on Cancer

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Abstract

Background

Distal bile duct cancer often invades the pancreas and/or duodenum. Invasion of the pancreas is defined as a T3 and that of the duodenum as a T4 tumor in the T classification of the American Joint Committee on Cancer (AJCC). The aim of this study was to assess whether this T classification is rational from the viewpoint of prognostic power.

Method

Ninety-five patients with distal bile duct cancer were retrospectively analyzed according to the current T classification of the AJCC.

Results

The main determinant of pT3 (n = 32) and pT4 (n = 30) was pancreatic and duodenal invasion, respectively, and the survival rates for patients with pT3 and pT4 are similar (p = 0.595). Duodenal invasion was present in 39% of the patients with pancreatic invasion, whereas pancreatic invasion was observed in 86% of those with duodenal invasion. The survival for patients with pancreatic invasion was not significantly different (p = 0.283) whether or not there was concomitant duodenal invasion (n = 19 and n = 37, respectively). Multivariate analysis identified venous invasion, distant metastasis, histologic grade, and pancreatic invasion as independent prognostic factors.

Conclusion

Although duodenal invasion usually occurs after pancreatic invasion, it is not a significant prognostic factor while pancreatic invasion is. The current T classification should be revised since it expresses tumor extension but does not reflect a survival in distal bile duct cancer.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan

    Tomoki Ebata, Masato Nagino, Hideki Nishio, Tsuyoshi Igami, Yukihiro Yokoyama & Yuji Nimura

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  1. Tomoki Ebata
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  2. Masato Nagino
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  3. Hideki Nishio
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  4. Tsuyoshi Igami
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  5. Yukihiro Yokoyama
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  6. Yuji Nimura
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Correspondence to Tomoki Ebata.

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Ebata, T., Nagino, M., Nishio, H. et al. Pancreatic and Duodenal Invasion in Distal Bile Duct Cancer: Paradox in the Tumor Classification of the American Joint Committee on Cancer. World J Surg 31, 2008–2015 (2007). https://doi.org/10.1007/s00268-007-9173-5

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