Author/Authors :
ma, wen-jie sichuan university - west china hospital - department of biliary surgery, Chengdu, China , wu, zhen-ru sichuan university - west china hospital - laboratory of pathology, Chengdu, China , shrestha, anuj sichuan university - west china hospital - department of biliary surgery, Chengdu, China , shrestha, anuj andaki medical college - department of general surgery, Pokhara, Nepal , yang, qin sichuan university - west china hospital - department of biliary surgery, Chengdu, China , hu, hai-jie sichuan university - west china hospital - department of biliary surgery, Chengdu, China , wang, jun-ke sichuan university - west china hospital - department of biliary surgery, Chengdu, China , liu, fei sichuan university - west china hospital - department of biliary surgery, Chengdu, China , zhou, rong-xing sichuan university - west china hospital - department of biliary surgery, Chengdu, China , li, quan-sheng sichuan university - west china hospital - department of biliary surgery, Chengdu, China , li, fu-yu sichuan university - west china hospital - department of biliary surgery, Chengdu, China
Abstract :
Background: The survival benefits of additional resection of the positive proximal ductal margin (PM) in hilar cholangiocarcinoma (HCCA) remains controversial. This retrospective study investigated the effectiveness of additional resection of the invasive cancer PM under different levels of preoperativecarbohydrate antigen 19-9 (CA19-9). Methods: Patients who underwent hepatectomy for HCCA from 2000 to 2017 were analyzed. Surgical variables, resection margin status, length of the PM (LPM), prognostic factors, and survival were evaluated. Results: A total of 228 patients were enrolled: 175 PM(−) without additional resection patients (group A), 21 PM(−) after additional resection (group B), 16 PM(+) without additional resection (group C), and 16 PM(+) after additional resection (group D). The median survival of group B (20.99 months) was similar to that of group A (23.00 months; P=0.16), and both were significantly better than those of group C (11.60 months) and D (9.50 months), especially when preoperative CA19-9 150 U/mL (P 0.05). The survival of patients with an LPM 10 mm was significantly better compared with those with an LPM ≤10 mm, especially when preoperative CA19-9 was 150 U/mL (P 0.05). Only in the LPM 10 mm group, the survival of group B was comparable with that of group A (P 0.05). Conclusions: HCCA patients could get a survival benefit from a negative PM resulting from additional resection. Survival could be comparable with that of negative PM without additional resection among HCCA patients. An LPM 10 mm is possibly more associated with better survival compared with whether additional resection of the positive PM is performed under different levels of preoperative CA19-9.
Keywords :
Klatskin tumor , margins of excision , bile ducts , antigens, neoplasm , carbohydrate antigen 19 , 9 (CA19 , 9)
