Additional resection of an intraoperative margin-positive proximal bile duct improves survival in patients with hilar cholangiocarcinoma.

Abstract:

OBJECTIVE:To assess the survival benefit of additional resection of an intraoperative positive proximal bile duct margin (BD(Marg)) in patients undergoing hepatectomy for hilar cholangiocarcinoma (HCCA). SUMMARY BACKGROUND DATA:Intraoperative evidence of invasive cancer at the proximal (BD(Marg)) is associated with a dismal survival irrespective of whether a final negative (BD(Marg)) is achieved with an additional resection. METHODS:Clinicopathologic, operative, and survival data of consecutive patients undergone curative intent hepatectomy with bile duct resection (n = 75) for HCC (1989-2010) were analyzed. RESULTS:Frozen-section examination of the proximal (BD(Marg)) revealed invasive cancer in 19 of the 67 patients. After additional resection, which was possible in 18 cases, a secondary R0 (BD(Marg)) resection was achieved in 15 patients (83.3%), with 2 of these having, at final pathology, positive radial and distal margins. Eventually, 8 patients were classified as R1 and 67 as R0 (54 primary R0 and 13 secondary R0). Median survival of patients who had a secondary R0 resection (30.6 months) was similar to that of primarily R0-resected patients (29.3 months) and significantly better than that of R1 patients (14.9 months) (P = 0.026). Median time to recurrence and site of recurrence were similar in R0 patients independently of the performance of an additional resection. The incidence of biliary fistula was significantly increased (44.4% vs 17.5%; P = 0.02) in patients necessitating a margin re-resection. CONCLUSIONS:Additional resection of a positive proximal (BD(Marg)) , albeit associated with an increased risk of biliary fistula, offers a significant survival benefit and should be attempted whenever possible.

journal_name

Ann Surg

journal_title

Annals of surgery

authors

Ribero D,Amisano M,Lo Tesoriere R,Rosso S,Ferrero A,Capussotti L

doi

10.1097/SLA.0b013e3182368f85

subject

Has Abstract

pub_date

2011-11-01 00:00:00

pages

776-81; discussion 781-3

issue

5

eissn

0003-4932

issn

1528-1140

pii

00000658-201111000-00014

journal_volume

254

pub_type

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