Skip to main content

Advertisement

SpringerLink
Log in

Prognosis and Circumferential Margin in Patients with Resected Hilar Cholangiocarcinoma

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

Abstract

Background

Resection margin status is a known prognosticator in patients who undergo resection for hilar cholangiocarcinoma. However, the influence of an isolated positive circumferential margin on clinical outcome is unclear.

Methods

Patients with resected de novo hilar cholangiocarcinoma from two European hepatobiliary centres (Medical University of Vienna and Aintree University Hospital, 2006–2016) were classified according to resection margin status (negative, surgically positive, isolated circumferentially positive) and investigated with respect to overall survival (OS), recurrence-free survival (RFS) and recurrence pattern.

Results

Eighty-three (48 male/35 female) patients were enrolled. The median age was 64 years (range 33–80). The median follow-up was 21.7 months (range 0.3–92.4). Forty (48%) patients had negative resection margins, 25 (30%) had an isolated positive circumferential margin and 18 (22%) had a positive surgical margin. The 5-year OS rates in patients with negative, isolated positive circumferential and positive surgical resection margins were 47%, 33% and 0%, respectively. Median OS was 45.6, 32.7 and 14.5 months, respectively (log rank, P = 0.011). Upon multivariable Cox regression analysis, resection margin status and lymph node status remained statistically significant (P < 0.05). No difference with respect to RFS and recurrence pattern was found between the groups (P > 0.05).

Conclusion

Our data show that these three resection margin types were associated with different clinical outcomes. Circumferential margin status may therefore serve as a novel prognostic biomarker.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Mansour JC, Aloia TA, Crane CH, Heimbach JK, Nagino M, Vauthey JN. Hilar cholangiocarcinoma: expert consensus statement. HPB (Oxford). 2015;17(8):691–99.

    Article  Google Scholar 

  2. Matsuo K, Rocha FG, Ito K, et al. The Blumgart preoperative staging system for hilar cholangiocarcinoma: analysis of resectability and outcomes in 380 patients. J Am Coll Surg. 2012;215(3):343–55.

    Article  Google Scholar 

  3. van Gulik TM, Kloek JJ, Ruys AT, et al. Multidisciplinary management of hilar cholangiocarcinoma (Klatskin tumor): extended resection is associated with improved survival. Eur J Surg Oncol. 2011;37(1):65–71.

    Article  Google Scholar 

  4. 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(1):129–40.

    Article  Google Scholar 

  5. Gomez D, Patel PB, Lacasia-Purroy C, et al. Impact of specialized multi-disciplinary approach and an integrated pathway on outcomes in hilar cholangiocarcinoma. Eur J Surg Oncol. 2014;40(1):77–84.

    Article  CAS  Google Scholar 

  6. Buettner S, van Vugt JL, Gani F, et al. A comparison of prognostic schemes for perihilar cholangiocarcinoma. J Gastrointest Surg. 2016;20(10):1716–1724.

    Article  Google Scholar 

  7. Zhang XF, Beal EW, Chakedis J, et al. Defining early recurrence of hilar cholangiocarcinoma after curative-intent surgery: a multi-institutional study from the US extrahepatic biliary malignancy consortium. World J Surg. 2018;42:2919–29.

    Article  Google Scholar 

  8. Fisher SB, Patel SH, Kooby DA, et al. Lymphovascular and perineural invasion as selection criteria for adjuvant therapy in intrahepatic cholangiocarcinoma: a multi-institution analysis. HPB (Oxford). 2012;14(8):514–22.

    Article  Google Scholar 

  9. Stremitzer S, Jones RP, Quinn LM, et al. Clinical outcome after resection of early-stage hilar cholangiocarcinoma. Eur J Surg Oncol. 2019;45(2):213–7.

    Article  Google Scholar 

  10. Shinohara K, Ebata T, Shimoyama Y, et al. A study on radial margin status in resected perihilar cholangiocarcinoma. Ann Surg. 2019.

  11. 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(4):396–402.

    Article  Google Scholar 

  12. Jamieson NB, Foulis AK, Oien KA, et al. Positive mobilization margins alone do not influence survival following pancreatico-duodenectomy for pancreatic ductal adenocarcinoma. Ann Surg. 2010;251(6):1003–10.

    Article  Google Scholar 

  13. De Vreede I, Steers JL, Burch PA, et al. Prolonged disease-free survival after orthotopic liver transplantation plus adjuvant chemoirradiation for cholangiocarcinoma. Liver Transpl. 2000;6(3):309–16.

    Article  Google Scholar 

  14. Rea DJ, Heimbach JK, Rosen CB, et al. Liver transplantation with neoadjuvant chemoradiation is more effective than resection for hilar cholangiocarcinoma. Ann Surg. 2005;242(3):451–458; discussion 458–461.

  15. Ethun CG, Lopez-Aguiar AG, Anderson DJ, et al. Transplantation versus resection for hilar cholangiocarcinoma: an argument for shifting treatment paradigms for resectable disease. Ann Surg. 2018;267(5):797–805.

    Article  Google Scholar 

  16. Chatelain D, Farges O, Fuks D, Trouillet N, Pruvot FR, Regimbeau JM. 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(5):1121–28.

    Article  Google Scholar 

Download references

Acknowledgment

The authors thank Katharina Woeran, MD, Clinical Institute of Pathology, Medical University Vienna, for providing the histological image of the circumferential resection margin presented as Supplementary Figure S1.

Author information

Authors and Affiliations

  1. Department of General Surgery, Medical University Vienna, Vienna, Austria

    Stefan Stremitzer MD, Johannes Laengle MD, PhD, Christoph Schwarz MD, PhD & Klaus Kaczirek MD

  2. Clinical Institute of Pathology, Medical University Vienna, Vienna, Austria

    Judith Stift MD

  3. North Western Hepatobiliary Unit, Aintree University Hospital, Liverpool, UK

    Robert P. Jones MD, Leonard M. Quinn MD, Stephen W. Fenwick MD, Rafael Diaz-Nieto MD, PhD, Graeme J. Poston MD & Hassan Z. Malik MD

Authors
  1. Stefan Stremitzer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Judith Stift MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Johannes Laengle MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christoph Schwarz MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Klaus Kaczirek MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Robert P. Jones MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Leonard M. Quinn MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Stephen W. Fenwick MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Rafael Diaz-Nieto MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Graeme J. Poston MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Hassan Z. Malik MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stefan Stremitzer MD.

Ethics declarations

Disclosures

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Fig. S1

Histopathological image showing a positive circumferential resection margin (tumour cells found at the inked edge, red arrow) and the remaining normal tissue (blue arrow) of a bile duct (TIFF 75945 kb)

Supplementary Fig. S2

RFS according to status of resection margins (log rank, P = 0.10) (TIFF 1501 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Stremitzer, S., Stift, J., Laengle, J. et al. Prognosis and Circumferential Margin in Patients with Resected Hilar Cholangiocarcinoma. Ann Surg Oncol 28, 1493–1498 (2021). https://doi.org/10.1245/s10434-020-09105-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-020-09105-1

Search

Navigation