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Annals of Surgical Oncology

, Volume 25, Issue 5, pp 1140–1149 | Cite as

The Impact of Intraoperative Re-Resection of a Positive Bile Duct Margin on Clinical Outcomes for Hilar Cholangiocarcinoma

  • Xu-Feng Zhang
  • Malcolm H. SquiresIII
  • Fabio Bagante
  • Cecilia G. Ethun
  • Ahmed Salem
  • Sharon M. Weber
  • Thuy Tran
  • George Poultsides
  • Andre Y. Son
  • Ioannis Hatzaras
  • Linda Jin
  • Ryan C. Fields
  • Matthew Weiss
  • Charles Scoggins
  • Robert C. G. Martin
  • Chelsea A. Isom
  • Kamron Idrees
  • Harveshp D. Mogal
  • Perry Shen
  • Shishir K. Maithel
  • Carl R. Schmidt
  • Timothy M. Pawlik
Hepatobiliary Tumors

Abstract

Background

The impact of re-resection of a positive intraoperative bile duct margin on clinical outcomes for resectable hilar cholangiocarcinoma (HCCA) remains controversial. We sought to define the impact of re-resection of an initially positive frozen-section bile duct margin on outcomes of patients undergoing surgery for HCCA.

Methods

Patients who underwent curative-intent resection for HCCA between 2000 and 2014 were identified at 10 hepatobiliary centers. Short- and long-term outcomes were analyzed among patients stratified by margin status.

Results

Among 215 (83.7%) patients who underwent frozen-section evaluation of the bile duct, 80 (37.2%) patients had a positive (R1) ductal margin, 58 (72.5%) underwent re-resection, and 29 ultimately had a secondary negative margin (secondary R0). There was no difference in morbidity, 30-day mortality, and length of stay among patients who had primary R0, secondary R0, and R1 resection (all p > 0.10). Median and 5-year survival were 22.3 months and 23.3%, respectively, among patients who had a primary R0 resection compared with 18.5 months and 7.9%, respectively, for patients with an R1 resection (p = 0.08). In contrast, among patients who had a secondary R0 margin with re-resection of the bile duct margin, median and 5-year survival were 30.6 months and 44.3%, respectively, which was comparable to patients with a primary R0 margin (p = 0.804). On multivariable analysis, R1 margin resection was associated with decreased survival (R1: hazard ratio [HR] 1.3, 95% confidence interval [CI] 1.0–1.7; p = 0.027), but secondary R0 resection was associated with comparable long-term outcomes as primary R0 resection (HR 0.9, 95% CI 0.4–2.3; p = 0.829).

Conclusions

Additional resection of a positive frozen-section ductal margin to achieve R0 resection was associated with improved long-term outcomes following curative-intent resection of HCCA.

Notes

Acknowledgment

Xu-Feng Zhang was supported in part by the Clinical Research Award of the First Affiliated Hospital of Xi’an Jiaotong University of China (No. XJTU1AF-CRF-2017-004).

Disclosures

None.

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Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Xu-Feng Zhang
    • 1
    • 2
  • Malcolm H. SquiresIII
    • 2
  • Fabio Bagante
    • 2
  • Cecilia G. Ethun
    • 3
  • Ahmed Salem
    • 4
  • Sharon M. Weber
    • 4
  • Thuy Tran
    • 5
  • George Poultsides
    • 5
  • Andre Y. Son
    • 6
  • Ioannis Hatzaras
    • 6
  • Linda Jin
    • 7
  • Ryan C. Fields
    • 7
  • Matthew Weiss
    • 8
  • Charles Scoggins
    • 9
  • Robert C. G. Martin
    • 9
  • Chelsea A. Isom
    • 10
  • Kamron Idrees
    • 10
  • Harveshp D. Mogal
    • 11
  • Perry Shen
    • 11
  • Shishir K. Maithel
    • 3
  • Carl R. Schmidt
    • 2
  • Timothy M. Pawlik
    • 2
    • 12
    • 13
  1. 1.Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and EngineeringThe First Affiliated Hospital of Xi’an Jiaotong UniversityXi’anChina
  2. 2.Department of SurgeryThe Ohio State University Wexner Medical CenterColumbusUSA
  3. 3.Division of Surgical Oncology, Department of Surgery, Winship Cancer InstituteEmory UniversityAtlantaUSA
  4. 4.Department of SurgeryUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  5. 5.Department of SurgeryStanford University Medical CenterStanfordUSA
  6. 6.Department of SurgeryNew York UniversityNew YorkUSA
  7. 7.Department of SurgeryWashington University School of MedicineSt LouisUSA
  8. 8.Division of Surgical Oncology, Department of SurgeryThe Johns Hopkins HospitalBaltimoreUSA
  9. 9.Division of Surgical Oncology, Department of SurgeryUniversity of LouisvilleLouisvilleUSA
  10. 10.Division of Surgical Oncology, Department of SurgeryVanderbilt University Medical CenterNashvilleUSA
  11. 11.Department of SurgeryWake Forest UniversityWinston-SalemUSA
  12. 12.Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer ResearchThe Ohio State University, Wexner Medical CenterColumbusUSA
  13. 13.Department of Oncology, Health Services Management and PolicyThe Ohio State University, Wexner Medical CenterColumbusUSA

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