Influence of Hepatic Resection Margin on Recurrence and Survival in Intrahepatic Cholangiocarcinoma View Full Text


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Article Info

DATE

2008-08-07

AUTHORS

Dietmar Tamandl, Beata Herberger, Birgit Gruenberger, Harald Puhalla, Markus Klinger, Thomas Gruenberger

ABSTRACT

BackgroundIntrahepatic 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.MethodsSeventy-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®).ResultsFifty-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).ConclusionHepatic 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. More... »

PAGES

2787-2794

References to SciGraph publications

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  • <error retrieving object. in <ERROR RETRIEVING OBJECT
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  • Identifiers

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    http://scigraph.springernature.com/pub.10.1245/s10434-008-0081-1

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    37 schema:description BackgroundIntrahepatic 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.MethodsSeventy-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®).ResultsFifty-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).ConclusionHepatic 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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    45 ICC
    46 MethodsSeventy-four patients
    47 R0 resection
    48 R1 group
    49 Western world
    50 analysis
    51 cholangiocarcinoma
    52 clearance
    53 complete tumor clearance
    54 curative intent
    55 curative surgery
    56 detail
    57 devices
    58 differences
    59 disease
    60 dissection device
    61 dissection technique
    62 distant recurrence
    63 examination
    64 extrahepatic spread
    65 factors
    66 free survival
    67 group
    68 hepatic recurrence
    69 hepatic resection margin
    70 histological examination
    71 influence
    72 institutions
    73 intent
    74 intrahepatic cholangiocarcinoma
    75 management
    76 margin
    77 median overall survival
    78 median recurrence-free survival
    79 minor role
    80 months
    81 mortality
    82 optimal surgical management
    83 overall survival
    84 patients
    85 perioperative mortality
    86 prognosis
    87 prognosis of ICC
    88 prognostic factors
    89 rare disease
    90 recurrence
    91 recurrence of disease
    92 recurrence-free survival
    93 resection
    94 resection margins
    95 role
    96 spread
    97 surgery
    98 surgical management
    99 survival
    100 technique
    101 tumor clearance
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