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Higher Tumor Burden Status Dictates the Impact of Surgical Margin Status on Overall Survival in Patients Undergoing Resection of Intrahepatic Cholangiocarcinoma

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The present study aimed to examine the prognostic significance of margin status following hepatectomy of intrahepatic cholangiocarcinoma (ICC) relative to overall tumor burden and nodal status.

Method

Patients who underwent curative-intent surgery for ICC between 1990 and 2017 were included from a multi-institutional database. The impact of margin status and width on overall survival (OS) was examined relative to TBS and preoperative nodal status.

Results

Among 1105 patients with ICC who underwent resection, median tumor burden score (TBS) was 6.1 (IQR 4.2–8.8) and 218 (19.7%) patients had N1 disease. More than one in eight patients had an R1 surgical margin (n = 154, 13.9%). Among patients with low or medium TBS, an increasing margin width was associated with an incrementally improved 5-year OS (R1 31.9% vs. 1–3 mm 38.5% vs. 3–10 mm 48.0% vs. ≥ 10 mm 52.3%). In contrast, among patients with a high TBS, margin width was not associated with better survival (R1 28.9% vs. 1–3 mm 22.8% vs. 3–10 mm 29.6% vs. ≥ 10 mm 13.7%). In addition, surgical margin status did not impact survival with cutoffs of TBS 7 or greater. Furthermore, patients with low or medium TBS and preoperative negative lymph nodes derived a survival benefit from an R0 resection (R1 resection, HR 2.15, 95% CI 1.35–3.44, p = 0.001). In contrast, margin status was not associated with prognosis among patients with a high TBS and preoperative positive/suspicious lymph nodes (R1 resection, HR 1.34, 95% CI 0.58–3.11, p = 0.50).

Conclusion

R0 resection and wider margin resection resulted in improved outcomes in patients with low tumor burden; however, the survival benefit of negative margin status disappeared in patients with underlying poor tumor biology.

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Author information

Authors and Affiliations

  1. Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA

    Yutaka Endo MD, PhD, Zorays Moazzam MD, Henrique A. Lima MD, Laura Alaimo MD & Timothy M. Pawlik MD, MPH, PhD, FACS, FRACS (Hon.)

  2. Department of Surgery, Stanford University, Stanford, CA, USA

    Kazunari Sasaki MD & George A. Poultsides MD

  3. Department of Surgery, University of Verona, Verona, Italy

    Laura Alaimo MD & Alfredo Guglielmi MD

  4. Department of Surgery, Ospedale San Raffaele, Milan, Italy

    Luca Aldrighetti MD

  5. Department of Surgery, John Hopkins Hospital, Baltimore, MD, USA

    Matthew Weiss MD

  6. Department of Surgery, University of Virginia, Charlottesville, VA, USA

    Todd W. Bauer MD

  7. Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania

    Sorin Alexandrescu MD

  8. Department of Surgery, Keio University, Tokyo, Japan

    Minoru Kitago MD, PhD

  9. Department of Surgery, Emory University, Atlanta, GA, USA

    Shishir K. Maithel MD

  10. Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal

    Hugo P. Marques MD

  11. Department of Surgery, University of Ottawa, Ottawa, Canada

    Guillaume Martel MD

  12. Department of Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia

    Carlo Pulitano MD

  13. Department of Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China

    Feng Shen MD

  14. Department of Hepatibiliopancreatic Surgery, APHP, Beaujon Hospital, Paris, France

    François Cauchy MD

  15. Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands

    Bas Groot Koerkamp MD

  16. Department of Gastroenterological Surgery, Yokohama City, University School of Medicine, Yokohama, Japan

    Itaru Endo MD, PhD

Authors
  1. Yutaka Endo MD, PhD
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  2. Kazunari Sasaki MD
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  8. Matthew Weiss MD
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  10. Sorin Alexandrescu MD
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  11. George A. Poultsides MD
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  15. Guillaume Martel MD
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  16. Carlo Pulitano MD
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  17. Feng Shen MD
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  18. François Cauchy MD
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  19. Bas Groot Koerkamp MD
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  20. Itaru Endo MD, PhD
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  21. Timothy M. Pawlik MD, MPH, PhD, FACS, FRACS (Hon.)
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Corresponding author

Correspondence to Timothy M. Pawlik MD, MPH, PhD, FACS, FRACS (Hon.).

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Endo, Y., Sasaki, K., Moazzam, Z. et al. Higher Tumor Burden Status Dictates the Impact of Surgical Margin Status on Overall Survival in Patients Undergoing Resection of Intrahepatic Cholangiocarcinoma. Ann Surg Oncol 30, 2023–2032 (2023). https://doi.org/10.1245/s10434-022-12803-7

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  • DOI: https://doi.org/10.1245/s10434-022-12803-7

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