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The Impact of Surgical Margin Status on Long-Term Outcome After Resection for Intrahepatic Cholangiocarcinoma

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

Abstract

Background

The influence of margin status on long-term outcome of patients undergoing liver resection for intrahepatic cholangiocarcinoma (ICC) remains controversial. We sought to study the impact of surgical tumor margin status on recurrence-free survival (RFS) and overall survival (OS) of patients undergoing resection for ICC.

Methods

From a multi-institutional database, 583 patients who underwent hepatic resection for ICC were identified. Demographics data, operative details, pathologic margin status, and long-term outcomes were collected and analyzed.

Results

Margin status was positive (R1) in 95 (17.8 %) patients; among patients who underwent an R0 resection (80.9 %), margin width was negative by 1–4 mm in 166 (31.0 %) patients, 5–9 mm in 100 (18.7 %) patients, and ≥1 cm in 174 (32.5 %) patients. Overall, 379 (65.0 %) patients had a recurrence: 61.5 % intrahepatic, 13.5 % extrahepatic, and 25.0 % both intra- and extrahepatic. Median and 5-year RFS and OS was 10.0 months and 9.2 %, and 26.4 months and 23.0 %, respectively. Patients who had an R1 resection had a higher risk of recurrence (hazard ratio [HR] 1.61, 95 % CI 1.15–2.27; p = 0.01) and shorter OS (HR 1.54, 95 % CI 1.12–2.11). Among patients with an R0 resection, margin width was also associated with RFS (1–4 mm: HR 1.32, 95 % CI 0.98–1.78 vs. 5–9 mm: HR 1.21, 95 % CI 0.89–1.66) and OS (1–4 mm: HR 1.95, 95 % CI 0.45–2.63 vs. 5–9 mm: HR 1.21, 95 % CI 0.88–1.68) (referent ≥1 cm; both p ≤ 0.002). Margin status and width remain independently associated with RFS and OS on multivariable analyses.

Conclusions

For patients undergoing resection of ICC, R1 margin status was associated with an inferior long-term outcome. Moreover, there was an incremental worsening RFS and OS as margin width decreased.

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Acknowledgment

The authors would like to thank Donielle Neal, Susana Rodrigues, John Miura, Francesca Ratti, Timothy Newhook, Malcolm H. Squires, and Stéphanie Meyer.

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Authors and Affiliations

  1. The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Gaya Spolverato MD, Mohammad Y. Yakoob MD, MS, PhD, Yuhree Kim MD, MPH & Timothy M. Pawlik MD, MPH, PhD, FACS

  2. Fundeni Clinical Institute, Bucharest, Romania

    Sorin Alexandrescu MD

  3. Curry Cabral Hospital, Lisbon, Portugal

    Hugo P. Marques MD & Jorge Lamelas MD

  4. Ospedale San Raffaele, Milan, Italy

    Luca Aldrighetti MD

  5. Medical College of Wisconsin, Milwaukee, WI, USA

    T. Clark Gamblin MD

  6. Emory University, Atlanta, GA, USA

    Shishir K. Maithel MD

  7. University of Sydney, Sydney, NSW, Australia

    Carlo Pulitano MD

  8. University of Virginia, Charlottesville, VA, USA

    Todd W. Bauer MD

  9. Eastern Hepatobiliary Surgery Hospital, Shanghai, China

    Feng Shen MD

  10. Stanford University, Stanford, CA, USA

    George A. Poultsides MD

  11. University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    J. Wallis Marsh MD

  12. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA

    Timothy M. Pawlik MD, MPH, PhD, FACS

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  1. Gaya Spolverato MD
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  2. Mohammad Y. Yakoob MD, MS, PhD
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  14. J. Wallis Marsh MD
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  15. Timothy M. Pawlik MD, MPH, PhD, FACS
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Correspondence to Timothy M. Pawlik MD, MPH, PhD, FACS.

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Spolverato, G., Yakoob, M.Y., Kim, Y. et al. The Impact of Surgical Margin Status on Long-Term Outcome After Resection for Intrahepatic Cholangiocarcinoma. Ann Surg Oncol 22, 4020–4028 (2015). https://doi.org/10.1245/s10434-015-4472-9

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