{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,7]],"date-time":"2026-06-07T23:33:27Z","timestamp":1780875207357,"version":"3.54.1"},"reference-count":32,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2007,7,28]],"date-time":"2007-07-28T00:00:00Z","timestamp":1185580800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2007,7,28]],"date-time":"2007-07-28T00:00:00Z","timestamp":1185580800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2007,7,28]],"date-time":"2007-07-28T00:00:00Z","timestamp":1185580800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2007,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Ninety\u2010five patients with distal bile duct cancer were retrospectively analyzed according to the current T classification of the AJCC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The main determinant of pT3 (<jats:italic>n<\/jats:italic> = 32) and pT4 (<jats:italic>n<\/jats:italic> = 30) was pancreatic and duodenal invasion, respectively, and the survival rates for patients with pT3 and pT4 are similar (<jats:italic>p<\/jats:italic> = 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 (<jats:italic>p<\/jats:italic> = 0.283) whether or not there was concomitant duodenal invasion (<jats:italic>n<\/jats:italic> = 19 and <jats:italic>n<\/jats:italic> = 37, respectively). Multivariate analysis identified venous invasion, distant metastasis, histologic grade, and pancreatic invasion as independent prognostic factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-007-9173-5","type":"journal-article","created":{"date-parts":[[2007,7,27]],"date-time":"2007-07-27T19:34:55Z","timestamp":1185564895000},"page":"2008-2015","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":51,"title":["Pancreatic and Duodenal Invasion in Distal Bile Duct Cancer: Paradox in the Tumor Classification of the American Joint Committee on Cancer"],"prefix":"10.1002","volume":"31","author":[{"given":"Tomoki","family":"Ebata","sequence":"first","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery Nagoya University Graduate School of Medicine 65 Tsurumai\u2010cho, Showa\u2010ku 466\u20108550 Nagoya Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masato","family":"Nagino","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery Nagoya University Graduate School of Medicine 65 Tsurumai\u2010cho, Showa\u2010ku 466\u20108550 Nagoya Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideki","family":"Nishio","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery Nagoya University Graduate School of Medicine 65 Tsurumai\u2010cho, Showa\u2010ku 466\u20108550 Nagoya Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsuyoshi","family":"Igami","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery Nagoya University Graduate School of Medicine 65 Tsurumai\u2010cho, Showa\u2010ku 466\u20108550 Nagoya Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukihiro","family":"Yokoyama","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery Nagoya University Graduate School of Medicine 65 Tsurumai\u2010cho, Showa\u2010ku 466\u20108550 Nagoya Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuji","family":"Nimura","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery Nagoya University Graduate School of Medicine 65 Tsurumai\u2010cho, Showa\u2010ku 466\u20108550 Nagoya Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2007,7,28]]},"reference":[{"key":"e_1_2_5_2_2","volume-title":"American Joint Committee on Cancer cancer staging manual","author":"Greene FL","year":"2002"},{"key":"e_1_2_5_3_2","volume-title":"American Joint Committee on Cancer cancer staging manual","author":"Fleming ID","year":"1997"},{"key":"e_1_2_5_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000094437.68038.a3"},{"key":"e_1_2_5_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199910283411807"},{"key":"e_1_2_5_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000658\u2010199610000\u201000005"},{"key":"e_1_2_5_7_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.21236"},{"key":"e_1_2_5_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000150166.94732.88"},{"key":"e_1_2_5_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000658\u2010198110000\u201000008"},{"key":"e_1_2_5_10_2","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1993.01420200045008"},{"key":"e_1_2_5_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF01659134"},{"key":"e_1_2_5_12_2","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v8.i5.943"},{"key":"e_1_2_5_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF00705323"},{"key":"e_1_2_5_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002\u20109610(79)90089\u20108"},{"key":"e_1_2_5_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000658\u2010199803000\u201000013"},{"key":"e_1_2_5_16_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365\u20102168.2002.02211.x"},{"key":"e_1_2_5_17_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000658\u2010199901000\u201000010"},{"key":"e_1_2_5_18_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000658\u2010200103000\u201000013"},{"key":"e_1_2_5_19_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000658\u2010199204000\u201000007"},{"key":"e_1_2_5_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF01658686"},{"key":"e_1_2_5_21_2","first-page":"170","article-title":"Hepatopancreatoduodenectomy for advanced carcinoma of the biliary tract","volume":"38","author":"Nimura Y","year":"1991","journal-title":"Hepatogastroenterology"},{"key":"e_1_2_5_22_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800780629"},{"key":"e_1_2_5_23_2","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.137.1.69"},{"key":"e_1_2_5_24_2","doi-asserted-by":"publisher","DOI":"10.1067\/msy.2001.114555"},{"key":"e_1_2_5_25_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000193604.72436.63"},{"key":"e_1_2_5_26_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800831217"},{"key":"e_1_2_5_27_2","first-page":"650","article-title":"Surgical treatment and postoperative outcomes for middle and lower bile duct carcinoma in Japan\u2010experience of a single institute","volume":"47","author":"Suzuki M","year":"2000","journal-title":"Hepatogastroenterology"},{"key":"e_1_2_5_28_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000143248.71964.29"},{"key":"e_1_2_5_29_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.4881"},{"key":"e_1_2_5_30_2","doi-asserted-by":"publisher","DOI":"10.1002\/1097\u20100142(20000801)89:3<508::AID\u2010CNCR5>3.0.CO;2\u2010D"},{"key":"e_1_2_5_31_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445-2197.1992.tb07044.x"},{"key":"e_1_2_5_32_2","doi-asserted-by":"publisher","DOI":"10.1038\/modpathol.3800380"},{"key":"e_1_2_5_33_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00423\u2010005\u20100561\u20108"}],"container-title":["World Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00268-007-9173-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00268-007-9173-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1007\/s00268-007-9173-5","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00268-007-9173-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,26]],"date-time":"2023-12-26T14:59:44Z","timestamp":1703602784000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1007\/s00268-007-9173-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2007,7,28]]},"references-count":32,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2007,10]]}},"alternative-id":["10.1007\/s00268-007-9173-5"],"URL":"https:\/\/doi.org\/10.1007\/s00268-007-9173-5","archive":["Portico"],"relation":{},"ISSN":["0364-2313","1432-2323"],"issn-type":[{"value":"0364-2313","type":"print"},{"value":"1432-2323","type":"electronic"}],"subject":[],"published":{"date-parts":[[2007,7,28]]},"assertion":[{"value":"28 July 2007","order":1,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}}]}}