{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T02:06:36Z","timestamp":1768442796775,"version":"3.49.0"},"reference-count":27,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2006,12,5]],"date-time":"2006-12-05T00:00:00Z","timestamp":1165276800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2007,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The importance of gallbladder carcinoma spread to the cystic duct has not yet been described. Although the cystic duct is contiguous with the gallbladder, it is located in the hepatoduodenal ligament and differs in structure from the gallbladder. The incidence and prognostic significance of cancer spread to the cystic duct in patients with gallbladder cancer is unclear.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Surgical specimens from 42 patients who underwent resection for advanced gallbladder carcinoma were examined retrospectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Altogether, 13 (31%) of the patients had cancer spread to the cystic duct. The incidences of perineural invasion, lymph node metastasis, and venous invasion were significantly higher in these patients than in the other 29 patients without cancer spread to the cystic duct (<jats:italic>P<\/jats:italic> = 0.027, 0.034, and 0.034, respectively). The 3\u2010 and 5\u2010year survival rates of these 13 patients were significantly lower than those of the other 29 patients (15.4% vs. 51.0% and 7.7% vs. 46.6%, respectively, <jats:italic>P<\/jats:italic> &lt; 0.0001 each). Multivariate analysis using the Cox proportional hazard model identified positive cancer spread to the cystic duct and depth of invasion (beyond serosa) as significant independent indicators of a poor prognosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Cancer spread to the cystic duct is an indicator of poor prognosis in patients with gallbladder carcinoma. This may be due to the high incidence of concomitant perineural invasion and lymph node metastasis associated with cancer spread.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-006-0118-1","type":"journal-article","created":{"date-parts":[[2006,12,16]],"date-time":"2006-12-16T05:04:51Z","timestamp":1166245491000},"page":"155-161","source":"Crossref","is-referenced-by-count":31,"title":["Impact of Tumor Spread to the Cystic Duct on the Prognosis of Patients with Gallbladder Carcinoma"],"prefix":"10.1002","volume":"31","author":[{"given":"Takenari","family":"Nakata","sequence":"first","affiliation":[{"name":"Department of Surgery Shinshu University School of Medicine Asahi 3\u20101\u20101 390\u20108621 Nagano Matsumoto Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akira","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Department of Surgery Shinshu University School of Medicine Asahi 3\u20101\u20101 390\u20108621 Nagano Matsumoto Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shiro","family":"Miwa","sequence":"additional","affiliation":[{"name":"Department of Surgery Shinshu University School of Medicine Asahi 3\u20101\u20101 390\u20108621 Nagano Matsumoto Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junpei","family":"Soeda","sequence":"additional","affiliation":[{"name":"Department of Surgery Shinshu University School of Medicine Asahi 3\u20101\u20101 390\u20108621 Nagano Matsumoto Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shinichi","family":"Miyagawa","sequence":"additional","affiliation":[{"name":"Department of Surgery Shinshu University School of Medicine Asahi 3\u20101\u20101 390\u20108621 Nagano Matsumoto Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2006,12,5]]},"reference":[{"key":"e_1_2_6_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s005340050170"},{"key":"e_1_2_6_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1072\u20107515(01)00814\u20106"},{"key":"e_1_2_6_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800830413"},{"key":"e_1_2_6_5_2","first-page":"2133","article-title":"Should the bile duct be preserved or removed in radical surgery for gallbladder cancer?","volume":"46","author":"Kosuge T","year":"1999","journal-title":"Hepatogastroenterology"},{"key":"e_1_2_6_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s005340100017"},{"key":"e_1_2_6_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00423\u2010002\u20100318\u20106"},{"key":"e_1_2_6_8_2","first-page":"717","article-title":"Indications for and operative outcome of hepato\u2010pancreatoduodenectomy in the treatment of carcinoma of the gallbladder (in Japanese with English abstract)","volume":"99","author":"Yoshikawa T","year":"1998","journal-title":"J Jpn Surg Soc"},{"key":"e_1_2_6_9_2","volume-title":"General rules for surgical and pathological studies on cancer of biliary tract","author":"Japanese Society of Biliary Surgery","year":"2003"},{"key":"e_1_2_6_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010002\u20106702\u20100"},{"key":"e_1_2_6_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s004230000163"},{"key":"e_1_2_6_12_2","volume-title":"International Union Against Cancer: TNM Classification of Malignant Tumors","author":"Sobin LH","year":"2002"},{"key":"e_1_2_6_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00423-002-0333-7"},{"key":"e_1_2_6_14_2","first-page":"382","article-title":"Anomalous pancreaticobiliary ductal junction without bile duct dilatation in gallbladder cancer","volume":"48","author":"Elnemr A","year":"2001","journal-title":"Hepatogastroenterology"},{"key":"e_1_2_6_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002\u20109610(97)00288\u20102"},{"key":"e_1_2_6_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2004.04.032"},{"key":"e_1_2_6_17_2","first-page":"2","volume-title":"Vagus nerves within the abdomen. 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