Influence of hepatic resection margin on recurrence and survival in intrahepatic cholangiocarcinoma

Department of Surgery, Hepatobiliary Service, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
Annals of Surgical Oncology (Impact Factor: 3.94). 09/2008; 15(10):2787-94. DOI: 10.1245/s10434-008-0081-1
Source: PubMed

ABSTRACT Intrahepatic cholangiocarcinoma (ICC) is a rare disease in the Western world, hence little is known about its optimal surgical management. We analyzed whether hepatic resection margin is a prognostic factor for local or distant recurrence and survival in patients resected with curative intent.
Seventy-four patients underwent potentially curative surgery for ICC at our institution from 1994 to 2007. Demographic, and tumor- and surgery-related details including hepatic resection margin were recorded, patients were followed up for recurrence and survival. All patients were resected using modern dissection devices (CUSA or Waterjet).
Fifty-nine patients (80%) underwent R0 resection, 15 (20%) had a resection margin greater than 10 mm (wide margin, WM) and 38 (51%) between 1 and 10 mm (close margin, CM). In 14 patients (19%), hepatic resection margin was involved on histological examination; perioperative mortalities were excluded from analysis (n = 7). Forty-seven patients developed recurrence (WM, CM, and R1): hepatic recurrence was observed in 40%, 58%, and 50% of patients; extrahepatic spread occurred in 27, 16, and 14%; and 33, 26, and 36% had no recurrence of disease so far (P = 0.755). There was no difference between groups regarding local versus disseminated hepatic recurrence. Median recurrence free survival was 11.4 months (WM), 9.8 months (CM), and 9.9 months (R1), respectively (P = 0.880). Median overall survival was 27.2 months (WM), 29.7 months (CM), and not reached in the R1 group, (P = 0.350).
Hepatic resection margin seems to play a minor role in the prognosis of ICC as long as complete tumor clearance can be achieved with a modern liver dissection technique.

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    • "However, patients with unresectable CCA typically have significantly higher CA 19-9 levels compared with patients with resectable CCA [126]. Other studies have noted that preoperative CA 19-9 values greater than 100 U/ml were also associated with worse recurrence-free survival after surgical resection [127]. Bile duct obstruction or acute cholangitis may affect CA 19-9 levels. "
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    • "In a recent series of 74 resected patients with ICC, Tamandl et al. stated that the median time between tumor recurrence and death was 16.4 months, and suggested that it might be increased by the use of a palliative treatment schedule [26]. "
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