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

Gaya Spolverato, Mohammad Y. Yakoob, Yuhree Kim, Sorin Alexandrescu, Hugo P. Marques, Jorge Lamelas, Luca Aldrighetti, T. Clark Gamblin, Shishir K. Maithel, Carlo Pulitano, Todd W. Bauer, Feng Shen, George A. Poultsides, J. Wallis Marsh, Timothy M. Pawlik

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)4020-4028
Number of pages9
JournalAnnals of Surgical Oncology
Volume22
Issue number12
DOIs
StatePublished - Nov 1 2015

ASJC Scopus subject areas

  • Surgery
  • Oncology

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