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Annals of Surgical Oncology
Erschienen in: Annals of Surgical Oncology 12/2015

01.11.2015 | Hepatobiliary Tumors

The Impact of Surgical Margin Status on Long-Term Outcome After Resection for Intrahepatic Cholangiocarcinoma

verfasst von: Gaya Spolverato, MD, Mohammad Y. Yakoob, MD, MS, PhD, Yuhree Kim, MD, MPH, Sorin Alexandrescu, MD, Hugo P. Marques, MD, Jorge Lamelas, MD, Luca Aldrighetti, MD, T. Clark Gamblin, MD, Shishir K. Maithel, MD, Carlo Pulitano, MD, Todd W. Bauer, MD, Feng Shen, MD, George A. Poultsides, MD, J. Wallis Marsh, MD, Timothy M. Pawlik, MD, MPH, PhD, FACS

Erschienen in: Annals of Surgical Oncology | Ausgabe 12/2015

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Abstract

Background

The influence of margin status on long-term outcome of patients undergoing liver resection for intrahepatic cholangiocarcinoma (ICC) remains controversial. We sought to study the impact of surgical tumor margin status on recurrence-free survival (RFS) and overall survival (OS) of patients undergoing resection for ICC.

Methods

From a multi-institutional database, 583 patients who underwent hepatic resection for ICC were identified. Demographics data, operative details, pathologic margin status, and long-term outcomes were collected and analyzed.

Results

Margin status was positive (R1) in 95 (17.8 %) patients; among patients who underwent an R0 resection (80.9 %), margin width was negative by 1–4 mm in 166 (31.0 %) patients, 5–9 mm in 100 (18.7 %) patients, and ≥1 cm in 174 (32.5 %) patients. Overall, 379 (65.0 %) patients had a recurrence: 61.5 % intrahepatic, 13.5 % extrahepatic, and 25.0 % both intra- and extrahepatic. Median and 5-year RFS and OS was 10.0 months and 9.2 %, and 26.4 months and 23.0 %, respectively. Patients who had an R1 resection had a higher risk of recurrence (hazard ratio [HR] 1.61, 95 % CI 1.15–2.27; p = 0.01) and shorter OS (HR 1.54, 95 % CI 1.12–2.11). Among patients with an R0 resection, margin width was also associated with RFS (1–4 mm: HR 1.32, 95 % CI 0.98–1.78 vs. 5–9 mm: HR 1.21, 95 % CI 0.89–1.66) and OS (1–4 mm: HR 1.95, 95 % CI 0.45–2.63 vs. 5–9 mm: HR 1.21, 95 % CI 0.88–1.68) (referent ≥1 cm; both p ≤ 0.002). Margin status and width remain independently associated with RFS and OS on multivariable analyses.

Conclusions

For patients undergoing resection of ICC, R1 margin status was associated with an inferior long-term outcome. Moreover, there was an incremental worsening RFS and OS as margin width decreased.
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Metadaten
Titel
The Impact of Surgical Margin Status on Long-Term Outcome After Resection for Intrahepatic Cholangiocarcinoma
verfasst von
Gaya Spolverato, MD
Mohammad Y. Yakoob, MD, MS, PhD
Yuhree Kim, MD, MPH
Sorin Alexandrescu, MD
Hugo P. Marques, MD
Jorge Lamelas, MD
Luca Aldrighetti, MD
T. Clark Gamblin, MD
Shishir K. Maithel, MD
Carlo Pulitano, MD
Todd W. Bauer, MD
Feng Shen, MD
George A. Poultsides, MD
J. Wallis Marsh, MD
Timothy M. Pawlik, MD, MPH, PhD, FACS
Publikationsdatum
01.11.2015
Verlag
Springer US
Erschienen in
Annals of Surgical Oncology / Ausgabe 12/2015
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-015-4472-9

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