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. 2021 Mar 1;273(3):572-578.
doi: 10.1097/SLA.0000000000003305.

A Study on Radial Margin Status in Resected Perihilar Cholangiocarcinoma

Kentaro Shinohara  1 , Tomoki Ebata  1 , Yoshie Shimoyama  2 , Takashi Mizuno  1 , Yukihiro Yokoyama  1 , Junpei Yamaguchi  1 , Shunsuke Onoe  1 , Nobuyuki Watanabe  1 , Masato Nagino  1
Affiliations

A Study on Radial Margin Status in Resected Perihilar Cholangiocarcinoma

Kentaro Shinohara et al. Ann Surg. .

Abstract

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.

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Conflict of interest statement

The authors report no conflicts of interest.

Comment in

References

    1. 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.
    1. 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.
    1. 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.
    1. 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.
    1. 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.

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