The Impact of Intraoperative Re-Resection of a Positive Bile Duct Margin on Clinical Outcomes for Hilar Cholangiocarcinoma

Annals of Surgical Oncology
Xu-Feng ZhangTimothy M Pawlik

Abstract

The impact of re-resection of a positive intraoperative bile duct margin on clinical outcomes for resectable hilar cholangiocarcinoma (HCCA) remains controversial. We sought to define the impact of re-resection of an initially positive frozen-section bile duct margin on outcomes of patients undergoing surgery for HCCA. Patients who underwent curative-intent resection for HCCA between 2000 and 2014 were identified at 10 hepatobiliary centers. Short- and long-term outcomes were analyzed among patients stratified by margin status. Among 215 (83.7%) patients who underwent frozen-section evaluation of the bile duct, 80 (37.2%) patients had a positive (R1) ductal margin, 58 (72.5%) underwent re-resection, and 29 ultimately had a secondary negative margin (secondary R0). There was no difference in morbidity, 30-day mortality, and length of stay among patients who had primary R0, secondary R0, and R1 resection (all p > 0.10). Median and 5-year survival were 22.3 months and 23.3%, respectively, among patients who had a primary R0 resection compared with 18.5 months and 7.9%, respectively, for patients with an R1 resection (p = 0.08). In contrast, among patients who had a secondary R0 margin with re-resection of the bile duct margin, med...Continue Reading

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Citations

Mar 10, 2018·Annals of Surgical Oncology·Thomas A Aloia
Jan 24, 2019·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Dingzhong PengNansheng Cheng
Sep 22, 2018·Annals of Gastroenterological Surgery·Toshifumi WakaiTakashi Kobayashi
Jul 17, 2020·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Ek Khoon TanCharles B Rosen
Oct 6, 2018·Annals of Surgical Oncology·Fabio Bagante, Timothy M Pawlik
Feb 4, 2021·Current Problems in Surgery·T Peter KinghamMichael I D'Angelica
Apr 5, 2019·Annals of Surgery·Kentaro ShinoharaMasato Nagino
Mar 6, 2021·Annals of Medicine and Surgery·Evangelos G BaltagiannisGeorgios K Glantzounis
Apr 12, 2021·World Journal of Surgical Oncology·Wenxuan WuJian Wu
Jun 17, 2021·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Xu-Feng ZhangTimothy M Pawlik
Mar 13, 2021·Visceral Medicine·Lynn E NooijenJoris I Erdmann

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