Journal of Surgery Concepts & Practice >

2021 , Vol. 26 >Issue 02: 130 - 137

DOI: https://doi.org/10.16139/j.1007-9610.2021.02.009

Original article

Effect of surgical margin width on prognosis in patients with single intrahepatic cholangiocarcinoma from a multicenter study

Expand
  • 1. Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital, Fujian Medical University, Fujian Fuzhou 350025, China
    2. Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Navy Medical University, Shanghai 200433, China
    3. Department of Hepatopancreatobiliary Surgery, Zhongda Hospital, Southeast University, Jiangsu Nanjing 210009, China
    4. Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang Hangzhou 310009, China
    5. Department of Biliary Surgery, Southwest Hospital, Army Medical University, Chongqing 400038, China
    6. Department of Hepatobi-liary Surgery, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
    7. Department of Biliary and Pancreatic Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Hubei Wuhan 430030, China
    8. Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
    9. Department of Biliary Surgery, West China Hospital, Sichuan University, Sichuan Chengdu 610041, China
    10. Department of Biliary and Pancreatic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
    11. Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
    12. Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Sichuan Nanchong 617000, China
    13. Department of General Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China

Received date: 2021-01-26

  Online published: 2022-07-27

Fold

Abstract

Objective To investigate the effect of wide surgical margin on the prognosis of patients with single intrahepatic cholangiocarcinoma (ICC) undergoing hepatectomy and the effect of microvascular invasion (MVI) on the treatment of hepatectomy with both wide surgical margin and narrow surgical margin. Methods From December 2011 to December 2017, the clinicopathological data of 302 patients with single ICC who underwent radical resection were retrospectively studied in 13 medical centers. According to the width of surgical margin, there were 126 patients (41.7%) in wide surgical margin group (≥1 cm) and 176 patients (58.3%) in narrow surgical margin group (<1 cm). Overall survival rate and disease-free survival rate of two groups were compared by Kaplan-Meier analysis. Subgroup analysis was conducted to compare the differences in prognosis of patients with different MVI. Results Using 1∶1 propensity score matching(PSM), 83 patients were in both wide surgical margin group and narrow surgical margin group, and there was no statistical difference in baseline data between two groups (all P>0.05). Disease-free survival rate in wide surgical margin group before PSM was significantly higher than that in narrow surgical margin group (P=0.005), while overall survival rate showed no statistically significant difference (P=0.053). After PSM, both overall survival rate and disease-free survival rate in wide surgical margin group were significantly higher than those in narrow surgical margin group (P<0.05). There was no statistically significant difference in both overall survival rate and disease-free survival rate among patients with MVI positive after liver resection with different surgical margins (P>0.05). In MVI negative group, however both overall survival rate and disease-free survival rate were significantly higher in the patients with wide surgical margin hepatectomy than in those with narrow surgical margin (P<0.05). Conclusions Wide surgical margin in hepatectomy can increase overall survival and disease-free survival in patients with single ICC, but does not improve prognosis when patients with MVI.

Key words： Intrahepatic cholangiocarcinoma; Surgical margin width; Microvascular invasion; Propensity score matching; Multicenter

Cite this article

LIU Hongzhi, LIN Ziguo, HUANG Jianlong, ZHOU Weiping, CHENG Zhangjun, LOU Jianying, ZHENG Shuguo, BI Xinyu, WANG Jianming, GUO Wei, LI Fuyu, WANG Jian, ZHENG Yamin, LI Jingdong, CHENG Shi, LIU Jingfeng, ZENG Yongyi . Effect of surgical margin width on prognosis in patients with single intrahepatic cholangiocarcinoma from a multicenter study[J]. Journal of Surgery Concepts & Practice, 2021 , 26(02) : 130 -137 . DOI: 10.16139/j.1007-9610.2021.02.009

References

[1] Rizvi S, Khan SA, Hallemeier CL, et al. Cholangiocarcinoma - evolving concepts and therapeutic strategies[J]. Nat Rev Clin Oncol, 2018, 15(2):95-111.
[2] Zhang H, Yang T, Wu M, et al. Intrahepatic cholangiocarcinoma: epidemiology, risk factors, diagnosis and surgical management[J]. Cancer Lett, 2016, 379(2):198-205.
[3] Benson AB, D′Angelica MI, Abbott DE, et al. Guidelines insights: hepatobiliary cancers, version 2.2019[J]. J Natl Compr Canc Netw, 2019, 17(4):302-310.
[4] 科技部传染病重大专项课题“病毒性肝炎相关肝癌外科综合治疗的个体化和新策略研究”专家组. 肝内胆管癌外科治疗中国专家共识(2020版)[J]. 中华消化外科杂志, 2021, 20(1):1-15.
[5] 梁后杰, 秦叔逵, 沈锋, 等. CSCO胆道系统肿瘤诊断治疗专家共识(2019年版)[J]. 临床肿瘤学杂志, 2019, 24(9):828-838.
[6] Zhang X, Li J, Shen F, et al. Significance of presence of microvascular invasion in specimens obtained after surgical treatment of hepatocellular carcinoma[J]. J Gastroenterol Hepatol, 2018, 33(2):347-354.
[7] Doussot A, Lim C, Gómez-Gavara C, et al. Multicentre study of the impact of morbidity on long-term survival following hepatectomy for intrahepatic cholangiocarcinoma[J]. Br J Surg, 2016, 103(13):1887-1894.
[8] Rodríguez-Perálvarez M, Luong TV, Andreana L, et al. A systematic review of microvascular invasion in hepatocellular carcinoma: diagnostic and prognostic variability[J]. Ann Surg Oncol, 2013, 20(1):325-339.
[9] Li MX, Bi XY, Li ZY, et al. Impaction of surgical margin status on the survival outcome after surgical resection of intrahepatic cholangiocarcinoma: a systematic review and meta-analysis[J]. J Surg Res, 2016, 203(1):163-173.
[10] Ribero D, Pinna AD, Guglielmi A, et al. Surgical approach for longterm survival of patients with intrahepatic cholangiocarcinoma: a multiinstitutional analysis of 434 patients[J]. Arch Surg, 2012, 147(12):1107-1113.
[11] Farges O, Fuks D, Boleslawski E, et al. Influence of surgical margins on outcome in patients with intrahepatic cholangiocarcinoma: a multicenter study by the AFC-IHCC-2009 study group[J]. Ann Surg,2011, 254(5):824-829.
[12] Watanabe Y, Matsuyama Y, Izumi N, et al. Effect of surgical margin width after R0 resection for intrahepatic cholangiocarcinoma: a nationwide survey of the Liver Cancer Study Group of Japan[J]. Surgery, 2020, 167(5):793-802.
[13] Mavros MN, Economopoulos KP, Alexiou VG, et al. Treatment and prognosis for patients with intrahepatic cholangiocarcinoma: systematic review and meta-analysis[J]. JAMA Surg, 2014, 149(6):565-574.
[14] Zhang XF, Xue F, Dong DH, et al. Number and station of lymph node metastasis after curative-intent resection of intrahepatic cholangiocarcinoma impact prognosis[J]. Ann Surg,2020-01-14.doi: 10.1097/SLA.0000000000003788.[online ahead of print].
[15] Spolverato G, Kim Y, Ejaz A, et al. Conditional probabi-lity of longterm survival after liver resection for intrahe-patic cholangiocarcinoma: a multi-institutional analysis of 535 patients[J]. JAMA Surg, 2015, 150(6):538-545.
[16] 施杰毅, 高强, 周俭, 等. 第8版AJCC肝内胆管癌TNM分期的解读与验证[J]. 外科理论与实践, 2018, 23(3):221-226.
[17] Hu LS, Weiss M, Popescu I, et al. Impact of microvascular invasion on clinical outcomes after curative-intent resection for intrahepatic cholangiocarcinoma[J]. J Surg Oncol, 2019, 119(1):21-29.
[18] Tsilimigras DI, Sahara K, Wu L, et al. Very early recurrence after liver resection for intrahepatic cholangiocarcinoma: considering alternative treatment approaches[J]. JAMA Surg, 2020, 155(9):823-831.
[19] Tang Z, Liu WR, Zhou PY, et al. Prognostic value and predication model of microvascular invasion in patients with intrahepatic cholangiocarcinoma[J]. J Cancer, 2019, 10(22):5575-5584.
[20] 曾永毅, 林自国, 刘红枝, 等. 微血管侵犯对肝内胆管癌根治性切除病人预后影响研究:基于多中心的倾向评分匹配分析[J]. 中国实用外科杂志, 2020, 40(6):695-702.
[21] Yang P, Si A, Yang J, et al. A wide-margin liver resection improves long-term outcomes for patients with HBV-related hepatocellular carcinoma with microvascular invasion[J]. Surgery, 2019, 165(4):721-730.
[22] 张小晶, 王琳. 微血管侵犯在肝癌综合诊断与治疗中的临床意义[J]. 中华消化外科杂志, 2019, 18(4):336-341.
[23] Lei Z, Li J, Wu D, et al. Nomogram for preoperative estimation of microvascular invasion risk in hepatitis B virus-related hepatocellular carcinoma within the Milan criteria[J]. JAMA Surg, 2016, 151(4):356-363.
[24] Xu X, Zhang HL, Liu QP, et al. Radiomic analysis of contrast-enhanced CT predicts microvascular invasion and outcome in hepatocellular carcinoma[J]. J Hepatol, 2019, 70(6):1133-1144.
[25] 刘红枝, 林海涛, 林昭旺, 等. 机器学习算法在肝细胞癌微血管侵犯术前预测中的应用价值[J]. 中华消化外科杂志, 2020, 19(2):156-165.
[26] Reames BN, Ejaz A, Koerkamp BG, et al. Impact of major vascular resection on outcomes and survival in patients with intrahepatic cholangiocarcinoma: a multi-institutional analysis[J]. J Surg Oncol, 2017, 116(2):133-139.
[27] Conci S, Viganò L, Ercolani G, et al. Outcomes of vascular resection associated with curative intent hepatectomy for intrahepatic cholangiocarcinoma[J]. Eur J Surg Oncol, 2020, 46(9):1727-1733.
[28] Beal EW, Cloyd JM, Pawlik TM. Surgical treatment of intrahepatic cholangiocarcinoma: current and emerging principles[J]. J Clin Med, 2020, 10(1):104.
[29] Sheng X, Ji Y, Ren GP, et al. A standardized pathological proposal for evaluating microvascular invasion of hepatocellular carcinoma: a multicenter study by LCPGC[J]. Hepatol Int, 2020, 14(6):1034-1047.
Options
Outlines

/

〈 〉