A Study on Radial Margin Status in Resected Perihilar Cholangiocarcinoma.
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
01 03 2021
01 03 2021
Historique:
pubmed:
5
4
2019
medline:
11
3
2021
entrez:
5
4
2019
Statut:
ppublish
Résumé
To investigate radial margin (RM) status in resected perihilar cholangiocarcinoma (PHCC) and to evaluate the incidence of positive RM and its effect on survival. Although numerous studies have reported on ductal margin (DM) status in resected PHCC, no studies have addressed RM status. Patients who underwent hepatectomy for PHCC between 2001 and 2014 were retrospectively reviewed. After formalin fixation, resected specimens were serially sectioned at 5-mm intervals. All serial sections were color-copied, and RMs and DMs were identified and indicated on the color copies. Among 478 patients, 85 (17.8%) had positive surgical margins (R1 resection); of the 85 patients, 37 had positive RM alone, 33 had positive DM alone, and the remaining 15 had both positive RM and positive DM. Overall, 52 (61.2%) patients had positive RM. The sites of positive RM included the liver transection plane (n = 20) and the dissection plane in the hepatoduodenal ligament (n = 32). RM positivity on the liver transection plane was higher in left hepatectomy than in other hepatectomies (9.2% vs 1.9%, P < 0.001). RM positivity in the hepatoduodenal ligament was higher in left-sided hepatectomy than in right-sided hepatectomy (8.7% vs 3.6%, P = 0.031). The survival of the patients with positive RM was poorer than that of R0 patients (MST 2.1 vs 4.9 yrs, P < 0.001) and was similar to that of patients with positive DM. Multivariate analysis identified positive RM as one of the independent prognostic factors. Positive RM was the most common cause of R1 resection of PHCC and had similarly negative effects on survival as positive DM. Meticulous handling of the resected specimen is important to accurately evaluate RM status together with DM status.
Sections du résumé
OBJECTIVE
To investigate radial margin (RM) status in resected perihilar cholangiocarcinoma (PHCC) and to evaluate the incidence of positive RM and its effect on survival.
BACKGROUND
Although numerous studies have reported on ductal margin (DM) status in resected PHCC, no studies have addressed RM status.
METHODS
Patients who underwent hepatectomy for PHCC between 2001 and 2014 were retrospectively reviewed. After formalin fixation, resected specimens were serially sectioned at 5-mm intervals. All serial sections were color-copied, and RMs and DMs were identified and indicated on the color copies.
RESULTS
Among 478 patients, 85 (17.8%) had positive surgical margins (R1 resection); of the 85 patients, 37 had positive RM alone, 33 had positive DM alone, and the remaining 15 had both positive RM and positive DM. Overall, 52 (61.2%) patients had positive RM. The sites of positive RM included the liver transection plane (n = 20) and the dissection plane in the hepatoduodenal ligament (n = 32). RM positivity on the liver transection plane was higher in left hepatectomy than in other hepatectomies (9.2% vs 1.9%, P < 0.001). RM positivity in the hepatoduodenal ligament was higher in left-sided hepatectomy than in right-sided hepatectomy (8.7% vs 3.6%, P = 0.031). The survival of the patients with positive RM was poorer than that of R0 patients (MST 2.1 vs 4.9 yrs, P < 0.001) and was similar to that of patients with positive DM. Multivariate analysis identified positive RM as one of the independent prognostic factors.
CONCLUSIONS
Positive RM was the most common cause of R1 resection of PHCC and had similarly negative effects on survival as positive DM. Meticulous handling of the resected specimen is important to accurately evaluate RM status together with DM status.
Identifiants
pubmed: 30946074
pii: 00000658-202103000-00026
doi: 10.1097/SLA.0000000000003305
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
572-578Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest.
Références
Nagino M, Ebata T, Yokoyama Y, et al. Evolution of surgical treatment for perihilar cholangiocarcinoma: a single-center 34-year review of 574 consecutive resections. Ann Surg 2013; 258:129–140.
Nuzzo G, Giuliante F, Ardito F, et al. Improvement in perioperative and long-term outcome after surgical treatment of hilar cholangiocarcinoma: results of an Italian multicenter analysis of 440 patients. Arch Surg 2012; 147:26–34.
de Jong MC, Marques H, Clary BM, et al. The impact of portal vein resection on outcomes for hilar cholangiocarcinoma: a multi-institutional analysis of 305 cases. Cancer 2012; 118:4737–4747.
Wiggers JK, Groot Koerkamp B, van Klaveren D, et al. Preoperative risk score to predict occult metastatic or locally advanced disease in patients with resectable perihilar cholangiocarcinoma on imaging. J Am Coll Surg 2018; 227:238–246.
Zhang XF, Squires MH, Bagante F, et al. The impact of intraoperative re-resection of positive bile duct margin on clinical outcomes for hilar cholangiocarcinoma. Ann Surg Oncol 2018; 25:1140–1149.
Komaya K, Ebata T, Yokoyama Y, et al. Recurrence after curative-intent resection of perihilar cholangiocarcinoma: analysis of a large cohort with a close postoperative follow-up approach. Surgery 2018; 163:732–738.
Ribero D, Amisano M, Lo Tesoriere R, et al. Additional resection of an intraoperative margin-positive proximal bile duct improves survival in patients with hilar cholangiocarcinoma. Ann Surg 2011; 254:776–781.
Shingu Y, Ebata T, Nishio H, et al. Clinical value of additional resection of a margin-positive proximal bile duct in hilar cholangiocarcinoma. Surgery 2010; 147:49–56.
Sakamoto Y, Kosuge T, Shimada K, et al. Prognostic factors of surgical resection in middle and distal bile duct cancer: an analysis of 55 patients concerning the significance of ductal and radial margins. Surgery 2005; 137:396–402.
Yokoyama Y, Ebata T, Igami T, et al. The predictive value of indocyanine green clearance in future liver remnant for posthepatectomy liver failure following hepatectomy with extrahepatic bile duct resection. World J Surg 2016; 40:1440–1447.
Ebata T, Nagino M, Kamiya J, et al. Hepatectomy with portal vein resection for hilar cholangiocarcinoma: audit of 52 consecutive cases. Ann Surg 2003; 238:720–727.
Nagino M, Nimura Y, Nishio H, et al. Hepatectomy with simultaneous resection of the portal vein and hepatic artery for advanced perihilar cholangiocarcinoma: an audit of 50 consecutive cases. Ann Surg 2010; 252:115–123.
Neuhaus P, Jonas S, Bechstein WO, et al. Extended resection for hilar cholangiocarcinoma. Ann Surg 1999; 230:808–818.
Ebata T, Yokoyama Y, Igami T, et al. Hepatopancreatoduodenectomy for cholangiocarcinoma: a single-center review of 85 consecutive patients. Ann Surg 2012; 256:297–305.
Ohkubo M, Nagino M, Kamiya J, et al. Surgical anatomy of the bile ducts at the hepatic hilum as applied to living donor liver transplantation. Ann Surg 2004; 239:82–86.
Wakai T, Shirai Y, Moroda T, et al. Impact of ductal resection margin status on long-term survival in patients undergoing resection for extrahepatic cholangiocarcinoma. Cancer 2005; 103:1210–1216.
Igami T, Nagino M, Oda K, et al. Clinicopathologic study of cholangiocarcinoma with superficial spread. Ann Surg 2009; 249:296–302.
David MN, Timothy MP, Yun SC. Amin MB, Edge SB, Greene FL, et al. Perihilar Bile Ducts. AJCC Cancer Staging Manual 8th ed.New York: Springer; 2016. 311–316.
Chatelain D, Farges O, Fuks D, et al. Assessment of pathology reports on hilar cholangiocarcinoma: the results of a nationwide, multicenter survey performed by the AFC-HC-2009 study group. J Hepatol 2012; 56:1121–1128.
Shimizu H, Kimura F, Yoshidome H, et al. Aggressive surgical resection for hilar cholangiocarcinoma of the left-side predominance: radicality and safety of left-sided hepatectomy. Ann Surg 2010; 251:281–286.
Sugiura T, Okamura Y, Ito T, et al. Left hepatectomy with combined resection and reconstruction of right hepatic artery for bismuth type I and II perihilar cholangiocarcinoma. World J Surg. 2018;43:894–901.
Natsume S, Ebata T, Yokoyama Y, et al. Clinical significance of left trisectionectomy for perihilar cholangiocarcinoma: an appraisal and comparison with left hepatectomy. Ann Surg 2012; 255:754–762.
Esaki M, Shimada K, Nara S, et al. Left hepatic trisectionectomy for advanced perihilar cholangiocarcinoma. Br J Surg 2013; 100:801–807.