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25.07.2017 | Original Article | Ausgabe 11/2017

Journal of Gastrointestinal Surgery 11/2017

Perioperative and Long-Term Outcome for Intrahepatic Cholangiocarcinoma: Impact of Major Versus Minor Hepatectomy

Zeitschrift:
Journal of Gastrointestinal Surgery > Ausgabe 11/2017
Autoren:
Xu-Feng Zhang, Fabio Bagante, Jeffery Chakedis, Dimitrios Moris, Eliza W. Beal, Matthew Weiss, Irinel Popescu, Hugo P. Marques, Luca Aldrighetti, Shishir K. Maithel, Carlo Pulitano, Todd W. Bauer, Feng Shen, George A. Poultsides, Oliver Soubrane, Guillaume Martel, B. Groot Koerkamp, Alfredo Guglielmi, Endo Itaru, Timothy M. Pawlik
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1007/​s11605-017-3499-6) contains supplementary material, which is available to authorized users.

Abstract

Background

The objective of the current study was to investigate both short- and long-term outcomes of patients undergoing curative-intent resection for intrahepatic cholangiocarcinoma (ICC) stratified by extent of hepatic resection relative to overall final pathological margin status.

Methods

One thousand twenty-three patients with ICC who underwent curative-intent resection were identified from a multi-institutional database. Demographic, clinicopathological, and operative data, as well as overall (OS) and recurrence-free survival (RFS) were compared among patients undergoing major and minor resection before and after propensity score matching.

Results

Overall, 608 (59.4%) patients underwent major hepatectomy, while 415 (40.6%) had a minor resection. Major hepatectomy was more frequently performed among patients who had large, multiple, and bilobar tumors. Roughly half of patients (n = 294, 48.4%) developed a postoperative complication following major hepatectomy versus only one fourth of patients (n = 113, 27.2%) after minor resection (p < 0.001). In the propensity model, patients who underwent major hepatectomy had an equivalent OS and RFS versus patients who had a minor hepatectomy (median OS, 38 vs. 37 months, p = 0.556; and median RFS, 20 vs. 18 months, p = 0.635). Patients undergoing major resection had comparable OS and RFS with wide surgical margin (≥10 and 5–9 mm), but improved RFS when surgical margin was narrow (1–4 mm) versus minor resection in the propensity model. In the Cox regression model, tumor characteristics and surgical margin were independently associated with long-term outcome.

Conclusions

Major hepatectomy for ICC was not associated with an overall survival benefit, yet was associated with increased perioperative morbidity. Margin width, rather than the extent of resection, affected long-term outcomes. Radical parenchymal-sparing resection should be advocated if a margin clearance of ≥5 mm can be achieved.

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Zusatzmaterial
Supplementary Table 1 (DOCX 12 kb)
11605_2017_3499_MOESM1_ESM.docx
Supplementary Table 2 (DOCX 15 kb)
11605_2017_3499_MOESM2_ESM.docx
Supplementary Fig. 1 (DOCX 266 kb)
11605_2017_3499_MOESM3_ESM.docx
Literatur
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