Results of positive proximal margin after resection for hilar cholangiocarcinoma: An analysis of 42 cases

Abstract

Background/Aims: Hilar cholangiocarcinoma (HC) is a tumor that invades the confluence of the left and right hepatic bile ducts. Surgery is the definitive treatment but is also technically demanding. Here, we report our experience on 42 patients who underwent surgical resection for HC. The aim of the present study was to evaluate the margin status of resected specimens on frozen sections and the impact of R1 resection margin on survival. Materials and Methods: A total of 42 patients with HC who underwent surgical resection in our clinic between January 2008 and January 2017 were included in the study. Patients' charts were evaluated retrospectively. Results: The 1-, 2-, and 4-year overall survival rates of the 42 patients were 76.2%, 40%, and 10.7%, respectively. The median survival rates of the patients with negative and positive proximal surgical margins were 22 (11.93-32.06) and 17 (14.43-19.56) months, respectively. There was no statistically significant difference between these two groups. Conclusion: In HC, surgery achieving negative proximal surgical margin is often very difficult. Our results demonstrate that frozen sections are reliable for the assessment of the invasion status of the proximal and distal ductal surgical margins. Although complete resection is potentially curative, survival of the patients with HC is still poor. If there is no distant metastasis at the time of diagnosis, then extirpating surgery should be encouraged as survival of the patients with positive and negative margins is not significantly different.

Prognostic Factors of Hilar Cholangiocarcinoma Patients After Surgical Resection

“…However, several authors have suggested that patients whose positive margins contain carcinoma could survive beyond 5 years. Volkan Öter et.al [25] reported that the survival of patients with tumor positive margins was not found to be worse than those with tumor negative margins. Further large volume prospective studies are required to identify the impact of positive proximal margins on the survival rate.…”

The Role of Portoenterostomy with Aggressive Hilar Dissection in Biliary Tract Tumors: Report of Case Series and Review of the Literature

“…In cases where the negative surgical margin (R0) cannot be achieved, and the tumor continues as R1 or R2, removal of the dissected tissue and tumor may become necessary. Disruption of the bleeding of the dissected bile ducts, enlargement of the hepatectomy limit, increased risk of developing liver failure, and comorbidities may remain in the operation drainage or palliative resection stage [17,18]. In some cases where the negative surgical margin is provided, segmental bile duct resection is necessary.…”

“…The 5-year survival rate was reported as 11-45% in patients undergoing curative resection and 0-23% in patients with R1 resection in the literature [10]. Many studies are stating that there is no difference between surgery with negative surgical margin and positive surgical margin, and also, some studies state that palliative resection positively affects survival [8,18]. The Mayo Clinic has reported promising results in 1, 3, and 5-year survival 92%, 82%, and 82%, respectively, in the series of liver transplantation after neoadjuvant therapy in selected hilar cholangiocarcinoma cases.…”

A Consensus Meeting on Expert Recommendations on Operating Specifications for Laparoscopic Radical Resection of Hilar Cholangiocarcinoma

“…Anatomical liver resection is the standard procedure for HCCA. To achieve R0 resection, it is recommended to carry out intraoperative frozen sections to confirm negative proximal and distal bile duct resection margins ( 5 – 8 ).…”