Effect of Margin Status on Survival After Resection of Hilar Cholangiocarcinoma in the Modern Era of Adjuvant Therapies

Abstract

Introduction Studies have shown that for patients with hilar cholangiocarcinoma (HC), survival is associated with negative resection margins (R0). This requires increasingly proximal resection, putting patients at higher risk for complications, which may delay chemotherapy. For patients with microscopically positive resection margins (R1), the use of modern adjuvant therapies may offset the effect of R1 resection. Methods Patients at our institution with HC undergoing curative-intent resection between January 2008 and July 2019 were identified by retrospective record review. Demographic data, operative details, tumor characteristics, postoperative outcomes, recurrence, survival, and follow-up were recorded. Patients with R0 margin were compared to those with R1 margin. Patients with R2 resection were excluded. Results Seventy-five patients underwent attempted resection with 34 (45.3%) cases aborted due to metastatic disease or locally advanced disease. Forty-one (54.7%) patients underwent curative-intent resection with R1 rate of 43.9%. Both groups had similar rates of adjuvant therapy (56.5% vs. 61.1%, P = .7672). Complication rates and 30 mortality were similar between groups (all P > .05). Both groups had similar median recurrence-free survival (R0 29.2 months vs. R1 27.8 months, P = .540) and median overall survival (R0 31.2 months vs. R1 38.8 months, P = .736) with similar median follow-up time (R0 29.9 months vs. R1 28.5 months, P = .8864). Conclusions At our institution, patients undergoing hepatic resection for HC with R1 margins have similar recurrence-free and overall survival to those with R0 margins. Complications and short-term mortality were similar. This may indicate that with use of modern adjuvant therapies obtaining an R0 resection is not an absolute mandate.

Liver Transplantation as a New Standard of Care in Patients With Perihilar Cholangiocarcinoma? Results From an International Benchmark Study

“…In addition, available data indicate failed curative resection in more than a third of the cases and documented local recurrence at 1 year in more than half of the "so called" curative resections. 14,[36][37] Such scenarios are even more harmful to patients than dropout before LT. The only definite results can come from a randomized trial, which unfortunately seems not feasible.…”

“…Similar information is also absent in most series of resection for PHC with many patients never reaching resection due to tumor progression; for example, during the waiting time after portal vein embolization or the discovery at surgery of previously undetected liver metastasis or peritoneal carcinomatosis. In addition, available data indicate failed curative resection in more than a third of the cases and documented local recurrence at 1 year in more than half of the “so called” curative resections 14,36–37. Such scenarios are even more harmful to patients than dropout before LT.…”

Bile metabolites as diagnostic biomarkers for perihilar cholangiocarcinoma

“…The 5-year survival rate of pCCA is low due to its particular anatomical location, low surgical resection rate, and the lack of good chemotherapy or targeted therapeutic drugs. The best way to obtain an accurate diagnosis in a minimally invasive manner for non-surgical patients is still a difficult problem 2,19 . At present, the means for invasive operation to obtain pathology include tissue biopsy guided by ultrasound (US), contrast EUS (enhanced ultrasound), EUS, ERCP, and CT.…”

Bile metabolites as diagnostic biomarkers for perihilar cholangiocarcinoma

“…The 5-year survival rate of pCCA is low due to its particular anatomical location, low surgical resection rate, and the lack of good chemotherapy or targeted therapeutic drugs. The best way to obtain an accurate diagnosis in a minimally invasive manner for non-surgical patients is still a di cult problem [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] .…”