Optimal Indications for Additional Resection of the Invasive Cancer-Positive Proximal Bile Duct Margin in Cases of Advanced Perihilar Cholangiocarcinoma
| Autor: | Seiji Oguro, Yoji Kishi, Satoshi Nara, Kazuaki Shimada, T Kosuge, Hidenori Ojima, Minoru Esaki |
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| Rok vydání: | 2014 |
| Předmět: |
Adult
Male medicine.medical_specialty Resection Surgical oncology Margin (machine learning) mental disorders medicine Hepatectomy Humans Neoplasm Invasiveness Perihilar Cholangiocarcinoma Survival rate Aged Neoplasm Staging Retrospective Studies Aged 80 and over Invasive carcinoma business.industry Bile duct Retrospective cohort study Middle Aged Prognosis Surgery Survival Rate Bile Ducts Intrahepatic medicine.anatomical_structure Bile Duct Neoplasms Oncology Multivariate Analysis Female Neoplasm Grading business Follow-Up Studies Klatskin Tumor |
| Zdroj: | Annals of Surgical Oncology. 22:1915-1924 |
| ISSN: | 1534-4681 1068-9265 |
| DOI: | 10.1245/s10434-014-4232-2 |
| Popis: | 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.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 CA19-964 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).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. |
| Databáze: | OpenAIRE |
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