title: An aggressive approach to extrahepatic cholangiocarcinomas is warranted: margin status does not impact survival after resection.
abstract: BACKGROUND
  With cholangiocarcinoma, the only hope of a cure is resection. This study was undertaken to determine the impact of margin status, stage, tumor location, and adjuvant therapy on survival after resection of extrahepatic cholangiocarcinoma.
  
  
  METHODS
  From 1985-2006, 91 patients underwent resections of cholangiocarcinomas. Margin status was codified as micro-/macroscopically negative, microscopically positive/ macroscopically negative, or micro-/macroscopically positive. Stage was determined using the AJCC classification (6th edition). Tumor location was classified as proximal, mid, or distal. Proximal tumors were resected by extrahepatic biliary resection with/without concomitant hepatic resection (n = 48), distal extrahepatic cholangiocarcinomas by pancreaticoduodenectomy (n = 35), and mid tumors by extrahepatic biliary resection alone (n = 8). Regression analysis and survival curve analysis were utilized. Data are presented as median, mean +/- standard deviation (SD).
  
  
  RESULTS
  Overall survival after resection was 21 months, 38 +/- 46.0. Survival was not impacted by margin status (R0 20 months, 35 +/- 45.1 versus R1 32 months, 45 +/- 49.4). AJCC stage inversely correlated with survival (p = 0.004, Spearman regression analysis). Tumor location did not impact upon survival (p = 0.57, log-rank test). For proximal tumors, survival after biliary resection was significantly impacted by the need for concomitant hepatectomy (15 months, 27 +/- 31.4 versus 41 months, 67 +/- 17.1). Utilization of adjuvant therapy significantly improved survival (33 months, 56 +/- 63.1 versus 19 months, 33 +/- 40.0) (p = 0.046, Spearman regression).
  
  
  CONCLUSIONS
  Survival after resection of extrahepatic cholangiocarcinoma is significantly impacted by AJCC stage, the use of adjuvant therapy, and in patients with proximal tumors, the need for concomitant hepatectomy. Margin status and tumor location do not impact survival. Cholangiocarcinomas should be aggressively resected irrespective of tumor location, even if resection might result in microscopically positive margins, and adjuvant therapy applied.
authors.affiliation: Department of Surgery, University of South Florida College of Medicine, Tampa General Hospital, Room F145, 1289, Tampa, FL 33601, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Hernandez
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Cowgill
authors.forename: Sam
authors.initials: S
authors.lastname: Al-Saadi
authors.forename: Desiree
authors.initials: D
authors.lastname: Villadolid
authors.forename: Sharona
authors.initials: S
authors.lastname: Ross
authors.forename: Emily
authors.initials: E
authors.lastname: Kraemer
authors.forename: Mark
authors.initials: M
authors.lastname: Shapiro
authors.forename: John
authors.initials: J
authors.lastname: Mullinax
authors.forename: Jennifer
authors.initials: J
authors.lastname: Cooper
authors.forename: Steven
authors.initials: S
authors.lastname: Goldin
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Zervos
authors.forename: Alexander
authors.initials: A
authors.lastname: Rosemurgy
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000401:mortality / Q000473:pathology* / Q000556:secondary / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D016019:Survival Analysis