Frozen section and permanent diagnoses of the bile duct margin in gallbladder and bile duct cancer

Abstract

The clinical course of patients with gallbladder or bile duct carcinoma remains dismal despite the recent advances of diagnostic and therapeutic modalities 1 x [1] Yamaguchi, K., Enjoji, M., and Nakayama, F. Cancer of extrahepatic bile duct: A clinicopathologic study of immunohistochemistry for CEA, CA19‐9 and p21. World J Surg. 1988; 12: 11–17 Crossref | PubMed | Scopus (29) | Google Scholar See all References , 2 x [2] Yamaguchi, K., Chijiiwa, K., Saiki, S., Shimizu, S., Takashima, M., and Tanaka, M. Carcinoma of the extrahepatic bile duct: Mode of spread and its prognostic significance. Hepato-Gastroenterology. 1997; 44: 1256–1261 PubMed | Google Scholar See all References , 3 x [3] Yamaguchi, K., Chijiiwa, K., Saiki, K., Nishihara, K., Takashima, M., Kawakami, K., and Tanaka, M. Retrospective analysis of 70 operation for gallbladder carcinoma. Br J Surg. 1997; 84: 200–204 Crossref | PubMed | Scopus (123) | Google Scholar See all References . Intramural and/or periductal invasion determined microscopically is sometimes more extensive than the invasion evaluated preoperatively. Some report a strong correlation between positive surgical margins and postoperative local recurrence 4 x [4] Bengmark, S., Ekberg, H., Evander, A., Klofver‐Stahl, B., and Tranberg, K.G. Major liver resection for hilar cholangiocarcinoma. Ann Surg. 1988; 207: 120–125 Crossref | PubMed | Scopus (164) | Google Scholar See all References , 5 x [5] Beazley, R., Hadjis, N., Benjamin, I., and Blumgart, L. Clinicopathological aspects of hilar bile duct cancer. Experience with resection and bypass surgical treatments. Ann Surg. 1984; 199: 623–636 Google Scholar See all References , 6 x [6] Bismuth, H., Nakache, R., and Diamond, T. Management strategies in resection for hilar cholangiocarcinoma. Ann Surg. 1992; 215: 31–38 Crossref | PubMed | Scopus (568) | Google Scholar See all References . Frozen sections are usually performed to decide the cutting margins of resection of the bile duct. However, the disagreement between frozen section diagnosis and permanent paraffin section diagnosis has been reported 7 x [7] Strong, R. and Lynch, S. Surgical resection for hilar cholangiocarcinoma. J Hep Bil Pancreat Surg. 1995; 2: 233–238 Crossref | Scopus (13) | Google Scholar See all References 7 , 8 x [8] Okazaki, Y., Horimi, T., Kotaka, M., Morita, S., and Takasaki, M. Study of the intrahepatic surgical margin of hilar bile duct carcinoma. Hepato-Gastroenterology. 2002; 49: 625–627 PubMed | Google Scholar See all References 8 and the surgeons could be embarrassed by any alteration of diagnosis 7 x [7] Strong, R. and Lynch, S. Surgical resection for hilar cholangiocarcinoma. J Hep Bil Pancreat Surg. 1995; 2: 233–238 Crossref | Scopus (13) | Google Scholar See all References 7 . An accurate assessment of frozen section is mandatory to decide the optimal operative procedure. There are many surgical margins including the bile duct in gallbladder or bile duct carcinoma, and recurrent modes including local recurrence and distant metastasis. In this communication, we concentrate on frozen section and permanent diagnoses of the bile duct margins and review their potential surgical implications on local recurrences.