Document Type: Research Articles
Department of Surgery, Faculty of Medicine, Khon Kaen University Khon Kaen, 40002, Thailand
Department of Radiology, Faculty of Medicine, Khon Kaen University Khon Kaen, 40002, Thailand
Department of Community Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
Department of Pathology, Faculty of Medicine, Khon Kaen University Khon Kaen, 40002, Thailand
Cancer Unit, Srinagarind Hospital, Khon Kaen University Khon Kaen, 40002, Thailand
Background: Intraductal papillary neoplasm of the bile duct (IPNB) is a specific entity for which there has been no classification that correlates clinical presentation with patient survival. We, therefore, propose a new classification based on radio-pathological appearance correlated with clinical findings including outcome. Methods: We retrospectively reviewed the medical and pathological records of 103 IPNB patients who underwent curative-intent hepatic resection between January 2008 and December 2011. A morphological classification was then created based on the presence of (a) bile duct dilatation, (b) intraductal mass(es), (c) cystic lesion(s), and (d) macro-invasion of the liver. All clinical parameters and survival were analyzed. Results: The median survival of IPNB patients was 1,728 days (95%CI: 1,485 to 1,971 days). The proposed classification predicted survival very well (log-rank test; p < 0.01). For patients with the cystic variant and micro-papillary IPNB, there were no tumor-related deaths within 3 years of surgery and median survival was not reached during the follow-up. The respective median survival times for IPNBs with unilateral intrahepatic duct dilatation, bilateral intrahepatic duct dilatation, and macro-invasion were 1,888 days (95%CI 1,118- 2,657), 673 days (95%CI: 392- 953), and 578 days (95%CI: 285- 870). Conclusion: We propose a new classification for IPNBs which not only provides a view of patients in terms of their radio-pathologic status but also should help in guiding planning of surgical procedures.