title: Influence of surgical margins on outcome in patients with intrahepatic cholangiocarcinoma: a multicenter study by the AFC-IHCC-2009 study group.
abstract: OBJECTIVE
  Define the optimal surgical margin in patients undergoing surgery for intrahepatic cholangiocarcinoma (IHCC).
  
  
  BACKGROUND
  Surgery is the most effective treatment for IHCC. However, the influence of R1 resection on outcome is controversial and that of margin width has not been evaluated.
  
  
  METHODS
  We studied 212 patients undergoing curative resection of mass-forming-type IHCC. The respective influences on survival of resection status (R0 vs R1), surgical margin width, pTNM stage, and the latter's components were evaluated.
  
  
  RESULTS
  Incidence of R1 resection was 24%. Overall, R1 resection was not an independent predictor of survival [odds ratio (OR) 1.2 (0.7-2.1)] in contrast to the pTNM stage [OR 2.10 (1.2-3.5)]. In the 78 pN+ patients, survival was similar after R0 and R1 resections (median: 18 vs 13 months, respectively, P = 0.1). In the 134 pN0 patients, R1 resection was an independent predictor of poor survival [OR 9.6 (4.5-20.4)], as was the presence of satellite nodules [OR 1.9 (1.1-3.2)]. In the 116 pN0 patients with R0 resections, median survival was correlated with margin width (≤1 mm: 15 months; 2-4 mm: 36 months; 5-9 mm: 57 month; ≥10 mm: 64 month, P < 0.001) and a margin >5 mm was an independent predictor of survival [OR 2.22 (1.59-3.09)].
  
  
  CONCLUSIONS
  Patients undergoing surgery for IHCC are at high risk of R1 resections. In pN0 patients, R1 resection is the strongest independent predictor of poor outcome and a margin of at least 5 mm should be created. The survival benefits of resection in pN+ patients and R1 resection in general are very low.
authors: Department of Hepatobiliary Surgery, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, AP-HP, Université Paris 7, Clichy, France. olivier.farges@bjn.aphp.fr
authors: Olivier
authors: O
authors: Farges
authors: David
authors: D
authors: Fuks
authors: Emmanuel
authors: E
authors: Boleslawski
authors: Yves-Patrice
authors: YP
authors: Le Treut
authors: Denis
authors: D
authors: Castaing
authors: Alexis
authors: A
authors: Laurent
authors: Christian
authors: C
authors: Ducerf
authors: Michel
authors: M
authors: Rivoire
authors: Philippe
authors: P
authors: Bachellier
authors: Laurence
authors: L
authors: Chiche
authors: Gennaro
authors: G
authors: Nuzzo
authors: Jean Marc
authors: JM
authors: Regimbeau
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D001662:Biliary Tract Surgical Procedures; D018281:Cholangiocarcinoma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D012189:Retrospective Studies; D016896:Treatment Outcome