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The Impact of Intraoperative Re-Resection of a Positive Bile Duct Margin on Clinical Outcomes for Hilar Cholangiocarcinoma

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

Abstract

Background

The impact of re-resection of a positive intraoperative bile duct margin on clinical outcomes for resectable hilar cholangiocarcinoma (HCCA) remains controversial. We sought to define the impact of re-resection of an initially positive frozen-section bile duct margin on outcomes of patients undergoing surgery for HCCA.

Methods

Patients who underwent curative-intent resection for HCCA between 2000 and 2014 were identified at 10 hepatobiliary centers. Short- and long-term outcomes were analyzed among patients stratified by margin status.

Results

Among 215 (83.7%) patients who underwent frozen-section evaluation of the bile duct, 80 (37.2%) patients had a positive (R1) ductal margin, 58 (72.5%) underwent re-resection, and 29 ultimately had a secondary negative margin (secondary R0). There was no difference in morbidity, 30-day mortality, and length of stay among patients who had primary R0, secondary R0, and R1 resection (all p > 0.10). Median and 5-year survival were 22.3 months and 23.3%, respectively, among patients who had a primary R0 resection compared with 18.5 months and 7.9%, respectively, for patients with an R1 resection (p = 0.08). In contrast, among patients who had a secondary R0 margin with re-resection of the bile duct margin, median and 5-year survival were 30.6 months and 44.3%, respectively, which was comparable to patients with a primary R0 margin (p = 0.804). On multivariable analysis, R1 margin resection was associated with decreased survival (R1: hazard ratio [HR] 1.3, 95% confidence interval [CI] 1.0–1.7; p = 0.027), but secondary R0 resection was associated with comparable long-term outcomes as primary R0 resection (HR 0.9, 95% CI 0.4–2.3; p = 0.829).

Conclusions

Additional resection of a positive frozen-section ductal margin to achieve R0 resection was associated with improved long-term outcomes following curative-intent resection of HCCA.

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Acknowledgment

Xu-Feng Zhang was supported in part by the Clinical Research Award of the First Affiliated Hospital of Xi’an Jiaotong University of China (No. XJTU1AF-CRF-2017-004).

Disclosures

None.

Author information

Authors and Affiliations

  1. Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China

    Xu-Feng Zhang MD, PhD

  2. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Xu-Feng Zhang MD, PhD, Malcolm H. Squires III MD, MS, Fabio Bagante MD, Carl R. Schmidt MD & Timothy M. Pawlik MD, MPH, PhD, FACS, FRACS (Hon.)

  3. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA

    Cecilia G. Ethun MD & Shishir K. Maithel MD

  4. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Ahmed Salem MD & Sharon M. Weber MD

  5. Department of Surgery, Stanford University Medical Center, Stanford, CA, USA

    Thuy Tran MD & George Poultsides MD

  6. Department of Surgery, New York University, New York, NY, USA

    Andre Y. Son MD & Ioannis Hatzaras MD

  7. Department of Surgery, Washington University School of Medicine, St Louis, MO, USA

    Linda Jin MD & Ryan C. Fields MD

  8. Division of Surgical Oncology, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA

    Matthew Weiss MD

  9. Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY, USA

    Charles Scoggins MD & Robert C. G. Martin MD

  10. Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA

    Chelsea A. Isom MD & Kamron Idrees MD

  11. Department of Surgery, Wake Forest University, Winston-Salem, NC, USA

    Harveshp D. Mogal MD & Perry Shen MD

  12. Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University, Wexner Medical Center, Columbus, OH, USA

    Timothy M. Pawlik MD, MPH, PhD, FACS, FRACS (Hon.)

  13. Department of Oncology, Health Services Management and Policy, The Ohio State University, Wexner Medical Center, Columbus, OH, USA

    Timothy M. Pawlik MD, MPH, PhD, FACS, FRACS (Hon.)

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  1. Xu-Feng Zhang MD, PhD
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  2. Malcolm H. Squires III MD, MS
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  9. Andre Y. Son MD
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  11. Linda Jin MD
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  12. Ryan C. Fields MD
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  13. Matthew Weiss MD
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  14. Charles Scoggins MD
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  15. Robert C. G. Martin MD
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  16. Chelsea A. Isom MD
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  17. Kamron Idrees MD
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  18. Harveshp D. Mogal MD
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  19. Perry Shen MD
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  20. Shishir K. Maithel MD
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  21. Carl R. Schmidt MD
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  22. Timothy M. Pawlik MD, MPH, PhD, FACS, FRACS (Hon.)
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Correspondence to Timothy M. Pawlik MD, MPH, PhD, FACS, FRACS (Hon.).

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Zhang, XF., Squires, M.H., Bagante, F. et al. The Impact of Intraoperative Re-Resection of a Positive Bile Duct Margin on Clinical Outcomes for Hilar Cholangiocarcinoma. Ann Surg Oncol 25, 1140–1149 (2018). https://doi.org/10.1245/s10434-018-6382-0

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  • DOI: https://doi.org/10.1245/s10434-018-6382-0

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