Impact of surgical margin width on long-term outcomes for intrahepatic cholangiocarcinoma: a multicenter study

Abstract

Background The objective of this study was to investigate the survival outcomes of surgical margin width in intrahepatic cholangiocarcinoma (ICC). 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 narrow margin hepatectomy (NMH) using the 1:1 propensity score matching (PSM). 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, subgroup analysis based on the AJCC staging system, WMH could only improve the survival outcomes in AJCC I ICC patients (Stage I: OS, DFS, P<0.05). Conclusions Surgeons should strive to achieve a wide surgical margin for patients with AJCC I ICC to optimize the long-term outcome.

The influence of resection margin width in patients with intrahepatic cholangiocarcinoma: a meta-analysis

“…Although these risk factors are usually comparable between groups in the studies we included, hierarchical analysis based on these risk factors is necessary, which may contribute to future treatment decisions. Studies have pointed out that CA-199 also has an impact on the prognosis of ICC; a lower level of CA-199 may be associated with a better prognosis, but the selection of different cutoff values leads to difficulties in data statistics [23,27]. In addition, hepatitis B virus infection is also considered to be associated with the prognosis of ICC in some studies, possibly because HBV infection can aggravate cirrhosis and reduce the volume of resectable liver [41][42][43].…”

“…Tumor stage is one of the most critical factors impacting the prognosis of ICC [47]. Despite the fact that many studies suggest that tumor stage is a predictive factor for ICC, only Liu et al revealed a link between tumor stage and survival [23]. Only patients in AJCC stage I with a large margin can enhance survival, according to Liu et al, while patients in AJCC stages II and III cannot benefit from a broad margin.…”

“…There were 56 records left after looking through the title and abstract. After applying the inclusion and exclusion criteria, 11 studies were found, none of which were RCTs [9,16,17,[20][21][22][23][24][25][26][27]. The results are displayed in Fig.…”

Radiomics Analysis of Contrast-Enhanced CT for the Preoperative Prediction of Microvascular Invasion in Mass-Forming Intrahepatic Cholangiocarcinoma

“…Some studies recommend that anatomical liver resection or wide resection margin is a priority for HCC patients with MVI (27)(28)(29)(30). In ICC patients, many studies suggested that a wide surgical margin may lead to favorable survival benefits (7,(31)(32)(33). Hu et al (32) reported that very early recurrence (defined as recurrence within 6 months) after ICC hepatectomy mostly occurred in the surgical margin site.…”

Surgical Aspects of Intrahepatic Cholangiocarcinoma

“…Spolverato et al found that one of six patients undergoing a hepatic resection due to ICC will have a positive margin, which was associated with a poor OS [ 37 ]. The impact of surgical margin width on long-term survival has been up to debate and was recently investigated by Liu et al in a multicenter study [ 38 ]. They found that a surgical margin of 10 mm or more was associated with a longer OS of 41 months compared to 22 months in patients with a narrow surgical margin of less than 10 mm.…”