The impact of positive resection margin in perihilar cholangiocarcinoma, ductal margin vs radial margin.

IF 2.1 3区医学 Q2 SURGERY

Langenbeck's Archives of Surgery Pub Date : 2024-11-26 DOI:10.1007/s00423-024-03547-x

Poowanai Sarkhampee, Weeris Ouransatien, Nithi Lertsawatvicha, Satsawat Chansitthichock, Paiwan Wattanarath

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引用次数: 0

Abstract

Introduction: Resection margin status is the important prognostic factor in resected perihilar cholangiocarcinoma (pCCA). Although the impact of ductal margin (DM) was reported in many studies, the influence of radial margin (RM) is unclear. This study aims to investigate the effect of positive RM on survival.

Methods: Patients with pCCA underwent curative resection between 2013 and 2018 were retrospectively reviewed. Resection margin status was divided into negative resection margin (R0) and positive resection margin (R1); positive RM alone (RM+) and positive DM with or without positive RM (DM+).

Results: Of the 167 pCCA patients, 62 (37.1%) had R1 margin. Among 62 R1 patients; 17 (27.4%) had positive DM alone, 20 (32.3%) had positive RM alone and 25 (40.3%) had both positive DM and RM. The R1 patients had a significantly greater number of lymph node metastasis (LNM) and advanced tumor staging than R0 patients, however there was no difference between the RM + and DM + patients. The median survival time of patients with RM + was significantly poorer than R0 patients (13.8 vs. 24.5 months; p < 0.001, respectively) and similar to the DM + patients (9.1 months, p = 0.556). However, in patients with LNM, those who underwent R0 resection had no statistically significant difference in survival outcomes compared to those with R1 resection.

Conclusion: Positive resection margin remains the important prognostic factor, and positive RM is common in these patients. Positive RM also had a comparable effect on survival as positive DM. As a result, in pCCA, surgical resection should target both RM and DM.

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肝周胆管癌切除切缘阳性的影响：导管切缘与径向切缘。

简介切除边缘状态是肝周胆管癌（pCCA）的重要预后因素。尽管许多研究都报道了导管缘（DM）的影响，但放射缘（RM）的影响尚不明确。本研究旨在探讨RM阳性对生存率的影响：回顾性分析2013年至2018年间接受根治性切除术的pCCA患者。切除边缘状态分为切除边缘阴性（R0）和切除边缘阳性（R1）；单纯RM阳性（RM+）和DM阳性伴或不伴RM阳性（DM+）：在167例pCCA患者中，62例（37.1%）的切除边缘为R1。在 62 例 R1 患者中，17 例（27.4%）仅有 DM 阳性，20 例（32.3%）仅有 RM 阳性，25 例（40.3%）同时有 DM 和 RM 阳性。与 R0 患者相比，R1 患者的淋巴结转移（LNM）数量和肿瘤晚期分期明显增加，但 RM + 和 DM + 患者之间没有差异。RM + 患者的中位生存时间明显低于 R0 患者（13.8 个月 vs. 24.5 个月；P 结论：阳性切除边缘仍然是肿瘤切除术的关键：切除边缘阳性仍是重要的预后因素，而RM阳性在这些患者中很常见。阳性 RM 对生存期的影响与阳性 DM 相当。因此，对于 pCCA，手术切除应同时针对 RM 和 DM。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Langenbeck's Archives of Surgery 医学-外科

CiteScore

3.30

自引率

8.70%

发文量

342

审稿时长

4-8 weeks

期刊介绍： Langenbeck''s Archives of Surgery aims to publish the best results in the field of clinical surgery and basic surgical research. The main focus is on providing the highest level of clinical research and clinically relevant basic research. The journal, published exclusively in English, will provide an international discussion forum for the controlled results of clinical surgery. The majority of published contributions will be original articles reporting on clinical data from general and visceral surgery, while endocrine surgery will also be covered. Papers on basic surgical principles from the fields of traumatology, vascular and thoracic surgery are also welcome. Evidence-based medicine is an important criterion for the acceptance of papers.