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Significance of proximal ductal margin status after resection of hilar cholangiocarcinoma
- Source :
- HPB. 23:109-117
- Publication Year :
- 2021
- Publisher :
- Elsevier BV, 2021.
-
Abstract
- Background The impact of additional resection for positive proximal bile duct margins during hepatic resection of hilar cholangiocarcinoma (HCCA) on survival and disease progression remains unclear. We asked how re-resection of positive proximal bile duct margins affected outcomes. Methods Patients undergoing resection between 1993–2017 were reviewed. Both frozen section and final margin status were reviewed. Overall survival was the primary outcome. Results 153 patients underwent surgical resection for HCCA. Median survival (months) for initial margin negative (M−), margin-positive to margin-negative (M+/M−) and margin-positive to margin-positive (M+/M+) was 45, 33, and 35 months respectively. Nodal metastases increased with margin positivity: 32% with M−, 49% with M+/M− and 63% with M+/M+ (p = 0.016). Local/regional progression more frequently occurred in M+/M− (27.3%) and M+/M+ (33.3%) patients (M+/M- vs. M-: p = 0.41, M+/M+ vs. M-: p = 0.27). Patients receiving postoperative chemotherapy were 33% M−, 46% M+/M− and 63% in M+/M+. Postoperative radiation was used in 13% of M−, 31% of M+/M− and 63% of M+/M+. Most frequent initial recurrences were within the liver and hepaticojejunostomy site. Conclusion Competing risk for systemic disease based on primary characteristics of HCCA outweighs the impact of re-resection to achieve R0 status. Improved survival will likely depend on future regional and systemic therapy.
- Subjects :
- medicine.medical_specialty
Hepatic resection
Gastroenterology
Resection
Cholangiocarcinoma
Internal medicine
medicine
Hepatectomy
Humans
Retrospective Studies
Frozen section procedure
Hepatology
Postoperative chemotherapy
Bile duct
business.industry
Postoperative radiation
Margin status
Bile Ducts, Intrahepatic
Treatment Outcome
medicine.anatomical_structure
Bile Duct Neoplasms
Neoplasm Recurrence, Local
business
Median survival
Klatskin Tumor
Subjects
Details
- ISSN :
- 1365182X
- Volume :
- 23
- Database :
- OpenAIRE
- Journal :
- HPB
- Accession number :
- edsair.doi.dedup.....6a86d9e7c4a3902cf8b0bd3d8541d062