Effect of surgical margin width after R0 resection for intrahepatic cholangiocarcinoma: A nationwide survey of the Liver Cancer Study Group of Japan

Watanabe, Yukihiro; Matsuyama, Yutaka; Izumi, Namiki; Kubo, Shoji; Kokudo, Norihiro; Sakamoto, Michiie; Shiina, Shuichiro; Takayama, Tadatoshi; Nakashima, Osamu; Kudo, Masatoshi

doi:10.1016/j.surg.2019.12.009

Cited by 43 publications

(36 citation statements)

References 43 publications

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“…Spearman's rank correlation and stepwise logistic regression analysis suggested that ICG fluorescence navigation was an important correlation factor and predictor of a wide margin. As a wide surgical margin should be a target of resection of malignant liver tumors [24][25][26][27], these results indicated that the patients in the ICG-FN group might have a lower postoperative recurrence rate and longer postoperative survival, although this still needs to be verified by long-term follow-up data.…”

Section: Discussionmentioning

confidence: 89%

“…A meta-analysis of 34 studies involving 11,147 hepatectomy patients concluded that patients with a wide margin (> 10 mm) had a better prognosis, suggesting that this should be one of the goals of hepatectomy [24]. Recent studies also identified that a wide surgical margin is predictive of a better long-term prognosis [25][26][27]. During laparoscopic surgery, the lack of tactile perception of laparoscopic forceps and the 2-dimensional image on the monitor in most centers might affect surgeons' evaluation of the resection range, which could be insufficient to preserve liver parenchyma, resulting in a narrow margin or a positive margin.…”

Section: Discussionmentioning

confidence: 99%

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Indocyanine green fluorescence navigation in laparoscopic hepatectomy: a retrospective single-center study of 120 cases

Liang

Qian

et al. 2020

Surg Today

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Purpose To explore the role of indocyanine green (ICG) fluorescence navigation in laparoscopic hepatectomy and investigate if the timing of its administration influences the intraoperative observation. Methods The subjects of this retrospective study were 120 patients who underwent laparoscopic hepatectomy; divided into an ICG-FN group (n = 57) and a non-ICG-FN group (n = 63). We analyzed the baseline data and operative data. Results There were no remarkable differences in baseline data such as demographic characteristics, lesion-related characteristics, and liver function parameters between the groups. Operative time and intraoperative blood loss were significantly lower in the ICG-FN group. The rate of R0 resection of malignant tumors was comparable in the ICG-FN and non-ICG-FN groups, but the wide surgical margin rate was significantly higher in the ICG-FN group. The administration of ICG 0–3 or 4–7 days preoperatively did not affect the intraoperative fluorescence imaging. Operative time, intraoperative blood loss, and a wide surgical margin correlated with ICG fluorescence navigation. ICG fluorescence navigation helped to minimize intraoperative blood loss and achieve a wide surgical margin. Conclusion ICG fluorescence navigation is safe and efficient in laparoscopic hepatectomy. It helps to achieve a wide surgical margin, which could result in a better prognosis. The administration of ICG 0–3 days preoperatively is acceptable.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Indocyanine green fluorescence navigation in laparoscopic hepatectomy: a retrospective single-center study of 120 cases

Liang

Qian

et al. 2020

Surg Today

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“…Among single-center studies focused on the effect of resection margins on survival, a small amount demonstrated a significant survival benefit for patients underwent WMH [21][22][23][24][25][26][27]. While all three multi-institutional studies and a meta-analysis show a consistent result that WMH could benefit long-term survival in patients with ICC [12,14,15]. In this study, we conducted a PSM analysis using multicenter ICC data, and discovered that patients underwent WMH had better outcomes compared with patients undergoing NMH.…”

Section: Discussionmentioning

confidence: 86%

Impact of Surgical Margin Width and Postoperative Adjuvant Therapy on Long-Term Outcomes for Intrahepatic Cholangiocarcinoma: A Propensity Score Matching Analysis

Liu¹,

Lin²,

Lin³

et al. 2020

Cancer Med J

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BACKGROUND The objective of this study was to investigate the survival outcomes of surgical margin width in intrahepatic cholangiocarcinoma (ICC), and evaluate the efficacy of postoperative adjuvant therapy (p-AT) in ICC patients underwent narrow-margin hepatectomy (NMH).METHODS Between November 2011 and August 2017, patients who underwent hepatectomy for ICC were collected from 13 major hepatopancreatobiliary centers in China. The survival outcomes for patients who underwent wide margin hepatectomy (WMH) were compared with those who underwent NMH using the 1:1 propensity score matching (PSM). For patients who underwent NMH, the relationship between p-AT and overall survival (OS) and disease-free survival (DFS) were analyzed. RESULTS Among 478 included patients, 195(40.8%) underwent WMH whereas 283(59.2%) underwent NMH. PSM yielded 79 matched patients with similar baseline characteristics. Patients underwent WMH had a significant better OS and DFS compared with those underwent NMH (before PSM: Median OS 27 vs. 17 months, P <0.05; Median DFS 15 vs. 8 months, P = 0.001), (after PSM: Median OS 41 vs. 22 months, p <0.05; Median DFS 16 vs. 10 months, p <0.05). However, based on the AJCC staging system, WMH could only improve the survival outcomes in early ICC patients (Stage I: OS, DFS, P <0.05; Stage II: OS, DFS, P >0.05; Stage III: OS, DFS, P >0.05). For patient underwent NMH, p-AT following NMH showed a better OS and RFS when compared to those who underwent NMH alone (OS, P = 0.05; DFS, p <0.05). CONCLUSION With the current data, we suggest surgeons should strive to achieve a wide surgical margin for patients with early ICC to optimize the long-term outcome. The effect of p-AT for the outcome of ICC patients underwent NMH need to be explored further.

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“…Surprisingly, positive resection margins did not have significant influence on postoperative survival, neither in uni- nor multivariable analysis. Of note, the width of the surgical margins was not analyzed in the present study since its relevance is generally discussed controversial: some recent publications pointed out that wide surgical margins (mostly defined as ≥ 10 mm) ensure better overall survival, whereas others reported conflicting results, especially with regard to lymph node–positive patients [ 36 , 37 ]. Other known histopathological factors including high AJCC/UICC stages were confirmed as risk factors in univariable analysis, but only an advanced T stage was identified as an independent risk factor for survival in multivariable analysis in this study.…”

Section: Discussionmentioning

confidence: 99%

Preoperative leukocytosis and the resection severity index are independent risk factors for survival in patients with intrahepatic cholangiocarcinoma

Beetz

Weigle

Cammann

et al. 2020

Langenbecks Arch Surg

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Purpose The incidence of intrahepatic cholangiocarcinoma is increasing worldwide. Despite advances in surgical and non-surgical treatment, reported outcomes are still poor and surgical resection remains to be the only chance for long-term survival of affected patients. The identification and validation of prognostic factors and scores, such as the recently introduced resection severity index, for postoperative morbidity and mortality are essential to facilitate optimal therapeutic regimens. Methods This is a retrospective analysis of 269 patients undergoing resection of histologically confirmed intrahepatic cholangiocarcinoma between February 1996 and September 2018 at a tertiary referral center for hepatobiliary surgery. Regression analyses were performed to evaluate potential prognostic factors, including the resection severity index. Results Median postoperative follow-up time was 22.93 (0.10–234.39) months. Severe postoperative complications (≥ Clavien-Dindo grade III) were observed in 94 (34.9%) patients. The body mass index (p = 0.035), the resection severity index (ASAT in U/l divided by Quick in % multiplied by the extent of liver resection graded in points; p = 0.006), additional hilar bile duct resection (p = 0.005), and number of packed red blood cells transfused during operation (p = 0.036) were independent risk factors for the onset of severe postoperative complications. Median Kaplan-Meier survival after resection was 27.63 months. Preoperative leukocytosis (p = 0.003), the resection severity index (p = 0.005), multivisceral resection (p = 0.001), and T stage ≥ 3 (p = 0.013) were identified as independent risk factors for survival. Conclusion Preoperative leukocytosis and the resection severity index are useful variables for preoperative risk stratification since they were identified as significant predictors for postoperative morbidity and mortality, respectively.

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Effect of surgical margin width after R0 resection for intrahepatic cholangiocarcinoma: A nationwide survey of the Liver Cancer Study Group of Japan

Cited by 43 publications

References 43 publications

Indocyanine green fluorescence navigation in laparoscopic hepatectomy: a retrospective single-center study of 120 cases

Indocyanine green fluorescence navigation in laparoscopic hepatectomy: a retrospective single-center study of 120 cases

Impact of Surgical Margin Width and Postoperative Adjuvant Therapy on Long-Term Outcomes for Intrahepatic Cholangiocarcinoma: A Propensity Score Matching Analysis

Preoperative leukocytosis and the resection severity index are independent risk factors for survival in patients with intrahepatic cholangiocarcinoma

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