Prognosis and Circumferential Margin in Patients with Resected Hilar Cholangiocarcinoma
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ORIGINAL ARTICLE – HEPATOBILIARY TUMORS
Prognosis and Circumferential Margin in Patients with Resected Hilar Cholangiocarcinoma Stefan Stremitzer, MD1, Judith Stift, MD2, Johannes Laengle, MD, PhD1, Christoph Schwarz, MD, PhD1, Klaus Kaczirek, MD1, Robert P. Jones, MD3, Leonard M. Quinn, MD3, Stephen W. Fenwick, MD3, Rafael Diaz-Nieto, MD, PhD3, Graeme J. Poston, MD3, and Hassan Z. Malik, MD3 Department of General Surgery, Medical University Vienna, Vienna, Austria; 2Clinical Institute of Pathology, Medical University Vienna, Vienna, Austria; 3North Western Hepatobiliary Unit, Aintree University Hospital, Liverpool, UK 1
ABSTRACT Background. Resection margin status is a known prognosticator in patients who undergo resection for hilar cholangiocarcinoma. However, the influence of an isolated positive circumferential margin on clinical outcome is unclear. Methods. Patients with resected de novo hilar cholangiocarcinoma from two European hepatobiliary centres (Medical University of Vienna and Aintree University Hospital, 2006–2016) were classified according to resection margin status (negative, surgically positive, isolated circumferentially positive) and investigated with respect to overall survival (OS), recurrence-free survival (RFS) and recurrence pattern. Results. Eighty-three (48 male/35 female) patients were enrolled. The median age was 64 years (range 33–80). The median follow-up was 21.7 months (range 0.3–92.4). Forty (48%) patients had negative resection margins, 25 (30%) had an isolated positive circumferential margin and 18 (22%) had a positive surgical margin. The 5-year OS rates in patients with negative, isolated positive circumferential and positive surgical resection margins were 47%, 33% and 0%, respectively. Median OS was 45.6, 32.7 and
Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-020-09105-1) contains supplementary material, which is available to authorized users. Ó Society of Surgical Oncology 2020 First Received: 5 May 2020 Accepted: 16 August 2020 S. Stremitzer, MD e-mail: [email protected]
14.5 months, respectively (log rank, P = 0.011). Upon multivariable Cox regression analysis, resection margin status and lymph node status remained statistically significant (P \ 0.05). No difference with respect to RFS and recurrence pattern was found between the groups (P [ 0.05). Conclusion. Our data show that these three resection margin types were associated with different clinical outcomes. Circumferential margin status may therefore serve as a novel prognostic biomarker.
Hilar cholangiocarcinoma is a malignant tumour originating from the extrahepatic bifurcation of the hepatic duct and is associated with poor prognosis in metastatic disease.1 In the absence of distant metastases, resection of the tumour-bearing extrahepatic bile duct in combination with liver resection, lymphadenectomy and Roux-en-Y hepaticojejunostomy is the gold standard of treatment and associated with 5-year survival rates of 20–45%.1–5 Negative prognosti
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