Shinji Tsutsumi

L1 Cell adhesion molecule (L1CAM) expression at the cancer invasive front is a novel prognostic marker of pancreatic ductal adenocarcinoma.

Pancreatic ductal adenocarcinoma (PDAC) is one of the most extremely aggressive cancers with a poor prognosis after curative resection. L1 cell adhesion molecule (L1CAM) is a 200–220 kDa type I transmembrane glycoprotein of the immunoglobulin superfamily, which has been shown to affect the prognosis of several cancers. No clinicopathological significance of L1CAM expression has been examined at the invasive front of PDAC. In this study, we examined the relationship between L1CAM expression and clinicopathological features in PDAC by immunohistochemistry.

Living donor liver transplantation in a pediatric patient with preexisting yolk sac tumor

There is ongoing discussion regarding the indications and timing of LT for patients with a preexisting extrahepatic malignancy. We herein report a pediatric case that underwent LDLT after therapy for YST. The patient, a 13‐year‐old female with biliary atresia, had undergone portoenterostomy at 2 months of age. She developed a left ovarian tumor with a high serum alpha‐fetoprotein concentration at 10 years of age. She underwent left oophorectomy and was diagnosed with ovarian YST (Stage I). After surgery, hepatopulmonary syndrome progressed gradually. She was examined carefully and exhibited no findings to suggest the recurrence of YST. We decided to perform LDLT at 3 years and 6 months of age after the surgery for YST. The patient is currently alive and doing well without recurrence of YST at approximately 2 years after transplantation. There is no significant difference between the recurrence rate of preexisting extrahepatic malignancy and the incidence of de novo malignancy if specific cases are selected. The indications and period from surgery for preexisting extrahepatic malignancy to LT should thus be determined according to the type and stage of cancer.

48 The Risk of Fresh Frozen Specimen-Dependent R0 Resection for Hilar Cholangiocarcinoma

Background: Most institutes use intraoperative bile ductal fresh frozen specimens (FFS) for achieving an R0 resection. However, this approach has the possibility to influence the local recurrence because of manipulating cancer lesion. METHODS: From September 1996 through September 2008, 40 patients with HCCA underwent a finally R0 resection in the department of gastroenterological surgery of Hirosaki University. Three patients were excluded because they did not have bile duct margins submitted for intraoperative frozen section analysis. We selected the positivity of invasive carcinoma at the first cut margin submitted for FFS (the first FFS) as the marker for manipulating cancer lesion. Medical records and pathological findings were reviewed to assess the other potential local recurrent risk factors (age, gender, operative type, portal vein resection, narrow bile ductal margin, narrow radial margin, Bismuth classification, and other tumor pathological factors). The local recurrent rates were analyzed using a logistic regression model. RESULTS: Total number of submitted FFS was 128. As compared to final histopathology, FFS had 75% positive predictive value and 100% negative predictive value. Six patients had invasive carcinoma at the first cut margin in final histopathology. According to the results of FFS, 4 patients underwent additional bile duct resection, 1 patient panceratoduodenectomy, and 1 patient right hepatectomy. The positivity of the first FFS had significant higher rate of the local recurrence as compared to no invasive carcinoma at the first FFS, respectively 67% and 20% (p=0.039). Multivariate analysis revealed the first FFS was the only risk factor with odds ratio of 8.00 (p=0.034). The survival is shorter in the local recurrent group compared to no local recurrent group with a 5 year survival of 11% and 65%, respectively (p=0.039). The positivity of the first FFS had the worse survival compared to no invasive carcinoma at the first FFS with a 5 year survival of 33% and 51%, respectively, but this difference did not show statistical significance (p=0.332). Conclusion: The positivity of the first FFS is the more important risk factor of the local recurrence than the narrow margin. This results show that the manipulation of cancer lesion might cause the spread of cancer to result in the local recurrence, so we should perform FFS-independent R0 resection for the better local control of HCCA.