title: Positive microscopic margins alter outcome in lymph node-negative cholangiocarcinoma when resection is combined with adjuvant radiotherapy.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the prognostic significance of positive microscopic margins in hilar cholangiocarcinoma in patients treated with resection and adjuvant radiotherapy.
  
  
  METHODS
  Between January 1983 and December 1997, 65 patients were definitively diagnosed with hilar cholangiocarcinoma and treated at our institution. Twenty-eight patients underwent curative resection. Of these patients, 23 received adjuvant radiotherapy with an average dose of 53 Gy (both external beam radiotherapy and low-dose rate brachytherapy). Portals included the preoperative primary tumor bed site with a 3- to 5-cm margin, the porta hepatis, and celiac lymph nodes. The patients with lymph node-negative pathologic specimens were reviewed, and an analysis of microscopic margins and subsequent impact on survival was determined with the Kaplan-Meier method and Wilcoxon test.
  
  
  RESULTS
  There were 16 patients who met inclusion criteria. There was no perioperative mortality. Seven patients had negative margins and 9 patients had positive microscopic margins. Median follow up was 55 months, and median survival was 24.5 months for the entire group. Median and 5-year survival were 21.5 months and 18.4% in the margin-negative group and 26 months and 15% in patients with positive margins (P = 0.45). These survival differences were not statistically significant.
  
  
  CONCLUSIONS
  Positive microscopic margins in lymph node-negative, resected hilar cholangiocarcinoma may not represent a negative prognostic factor when resection is combined with postoperative radiotherapy in this cohort. Further prospective, randomized studies are required to fully elucidate the benefits of adjuvant radiotherapy.
authors.affiliation: Department of Surgery, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: David E
authors.initials: DE
authors.lastname: Stein
authors.forename: Dwight E
authors.initials: DE
authors.lastname: Heron
authors.forename: Ernest L
authors.initials: EL
authors.lastname: Rosato
authors.forename: Pramila Rani
authors.initials: PR
authors.lastname: Anné
authors.forename: Allan K
authors.initials: AK
authors.lastname: Topham
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D001653:Bile Ducts, Intrahepatic; D001918:Brachytherapy; D018281:Cholangiocarcinoma / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016019:Survival Analysis