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Optimal Indications for Additional Resection of the Invasive Cancer-Positive Proximal Bile Duct Margin in Cases of Advanced Perihilar Cholangiocarcinoma

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The survival benefits of additional resection of the positive proximal ductal margin in cases of perihilar cholangiocarcinoma remain to be elucidated. The purpose of this retrospective study was to clarify the optimal indications for additional resection of the invasive cancer-positive proximal ductal margin (PM)

Methods

All patients who underwent hepatectomy for perihilar cholangiocarcinoma between 2000 and 2011 were analyzed. Surgical variables, the status of the PM, prognostic factors, and survival were evaluated.

Results

A total of 224 patients were enrolled. Additional resection was performed in 52 of 75 positive PMs of invasive cancer, resulting in 43 negative PMs. The survival of patients with a negative PM treated with additional resection (n = 43) was significantly worse than that of the patients with a negative PM treated without additional resection (n = 149; P = 0.031) and did not significantly differ from that of the patients with a positive PM (n = 32; P = 0.215). A multivariate analysis demonstrated that the carbohydrate antigen 19-9 (CA19-9) level (<64 or ≥64), combined vascular resection, pN, pM, the histological grade, perineural invasion, liver invasion, and R status were independent prognostic factors. Only in the subgroups of CA19-9 < 64 and pM0, the survival of the patients with a negative PM treated with additional resection was significantly better than that of the patients with a positive PM (P = 0.019 and P = 0.021, respectively).

Conclusions

Additional resection of the invasive cancer-positive PMs may be warranted only in limited patients with a lower level of CA19-9 and no distant metastatic disease.

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Acknowledgments

This study was supported by National Cancer Center Research and Development Fund (21-7-5).

Conflicts of Interest and Source of Funding

This study was supported by National Cancer Center Research and Development Fund (21-7-5). All authors have nothing to disclose any potential conflicts (financial, professional, or personal).

DISCLOSURE

The authors declare no conflicts of interest.

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Authors and Affiliations

  1. Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan

    Seiji Oguro MD, Minoru Esaki MD, PhD, Yoji Kishi MD, PhD, Satoshi Nara MD, Kazuaki Shimada MD, PhD & Tomoo Kosuge MD, PhD

  2. Pathology Division, National Cancer Center Research Institute, Chuo-ku, Tokyo, Japan

    Hidenori Ojima MD, PhD

  3. Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan

    Seiji Oguro MD & Tomoo Kosuge MD, PhD

Authors
  1. Seiji Oguro MD
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  2. Minoru Esaki MD, PhD
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  3. Yoji Kishi MD, PhD
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  4. Satoshi Nara MD
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  5. Kazuaki Shimada MD, PhD
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  6. Hidenori Ojima MD, PhD
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  7. Tomoo Kosuge MD, PhD
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Corresponding author

Correspondence to Minoru Esaki MD, PhD.

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Oguro, S., Esaki, M., Kishi, Y. et al. Optimal Indications for Additional Resection of the Invasive Cancer-Positive Proximal Bile Duct Margin in Cases of Advanced Perihilar Cholangiocarcinoma. Ann Surg Oncol 22, 1915–1924 (2015). https://doi.org/10.1245/s10434-014-4232-2

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  • DOI: https://doi.org/10.1245/s10434-014-4232-2

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