Impact of surgical margin width on prognosis and recurrence in intrahepatic cholangiocarcinoma: A single-center retrospective study

Abstract

Background The impact of the surgical margin (SM) on long-term survival remains controversial. This study retrospectively investigated the impact of the SM on prognosis and recurrence of intrahepatic cholangiocarcinoma (ICC) and evaluated the optimal margin width. Methods We reviewed the medical records of 58 ICC patients who underwent macroscopically curative surgery. Results The patients were classified into five categories according to the SM; R1, 0 to < 1 mm, 1 to < 5 mm, 5 to < 10 mm, and ≥ 10 mm. The prognosis tended to be different for SM < 1 mm or SM ≥ 1 mm, therefore, the cut-off value was set at 1 mm. Thirty-three (56.9%) patients had an SM ≥ 1 mm, and 25 (43.1%) had an SM < 1 mm. The multivariate analysis identified SM < 1 mm (p = 0.027) and microvascular invasion (p = 0.026) as independent prognostic factors of overall survival. After the propensity score-matching based on tumor-related factors, the overall survival and relapse-free survival rates of the SM < 1 mm group were significantly lower than those of the SM ≥ 1 mm group (p = 0.013 and p = 0.025, respectively). Peritoneal dissemination was significantly increased in the SM < 1 mm group than in the SM ≥ 1 mm group (p = 0.007). The post-recurrence survival rate of the SM < 1 mm group was significantly lower than that of the SM ≥ 1 mm group (p = 0.012). Conclusions This study suggests that an SM of at least 1 mm should be achieved during ICC resection. An SM < 1 mm may indicate a higher risk of peritoneal dissemination.