title: The Impact of Surgical Margin Status on Long-Term Outcome After Resection for Intrahepatic Cholangiocarcinoma.
abstract: BACKGROUND
  The influence of margin status on long-term outcome of patients undergoing liver resection for intrahepatic cholangiocarcinoma (ICC) remains controversial. We sought to study the impact of surgical tumor margin status on recurrence-free survival (RFS) and overall survival (OS) of patients undergoing resection for ICC.
  
  
  METHODS
  From a multi-institutional database, 583 patients who underwent hepatic resection for ICC were identified. Demographics data, operative details, pathologic margin status, and long-term outcomes were collected and analyzed.
  
  
  RESULTS
  Margin status was positive (R1) in 95 (17.8 %) patients; among patients who underwent an R0 resection (80.9 %), margin width was negative by 1-4 mm in 166 (31.0 %) patients, 5-9 mm in 100 (18.7 %) patients, and ≥1 cm in 174 (32.5 %) patients. Overall, 379 (65.0 %) patients had a recurrence: 61.5 % intrahepatic, 13.5 % extrahepatic, and 25.0 % both intra- and extrahepatic. Median and 5-year RFS and OS was 10.0 months and 9.2 %, and 26.4 months and 23.0 %, respectively. Patients who had an R1 resection had a higher risk of recurrence (hazard ratio [HR] 1.61, 95 % CI 1.15-2.27; p = 0.01) and shorter OS (HR 1.54, 95 % CI 1.12-2.11). Among patients with an R0 resection, margin width was also associated with RFS (1-4 mm: HR 1.32, 95 % CI 0.98-1.78 vs. 5-9 mm: HR 1.21, 95 % CI 0.89-1.66) and OS (1-4 mm: HR 1.95, 95 % CI 0.45-2.63 vs. 5-9 mm: HR 1.21, 95 % CI 0.88-1.68) (referent ≥1 cm; both p ≤ 0.002). Margin status and width remain independently associated with RFS and OS on multivariable analyses.
  
  
  CONCLUSIONS
  For patients undergoing resection of ICC, R1 margin status was associated with an inferior long-term outcome. Moreover, there was an incremental worsening RFS and OS as margin width decreased.
authors.affiliation: The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Gaya
authors.initials: G
authors.lastname: Spolverato
authors.affiliation: The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Mohammad Y
authors.initials: MY
authors.lastname: Yakoob
authors.affiliation: The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Yuhree
authors.initials: Y
authors.lastname: Kim
authors.affiliation: Fundeni Clinical Institute, Bucharest, Romania.
authors.forename: Sorin
authors.initials: S
authors.lastname: Alexandrescu
authors.affiliation: Curry Cabral Hospital, Lisbon, Portugal.
authors.forename: Hugo P
authors.initials: HP
authors.lastname: Marques
authors.affiliation: Curry Cabral Hospital, Lisbon, Portugal.
authors.forename: Jorge
authors.initials: J
authors.lastname: Lamelas
authors.affiliation: Ospedale San Raffaele, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Aldrighetti
authors.affiliation: Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: T Clark
authors.initials: TC
authors.lastname: Gamblin
authors.affiliation: Emory University, Atlanta, GA, USA.
authors.forename: Shishir K
authors.initials: SK
authors.lastname: Maithel
authors.affiliation: University of Sydney, Sydney, NSW, Australia.
authors.forename: Carlo
authors.initials: C
authors.lastname: Pulitano
authors.affiliation: University of Virginia, Charlottesville, VA, USA.
authors.forename: Todd W
authors.initials: TW
authors.lastname: Bauer
authors.affiliation: Eastern Hepatobiliary Surgery Hospital, Shanghai, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Shen
authors.affiliation: Stanford University, Stanford, CA, USA.
authors.forename: George A
authors.initials: GA
authors.lastname: Poultsides
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: J Wallis
authors.initials: JW
authors.lastname: Marsh
authors.affiliation: The Johns Hopkins University School of Medicine, Baltimore, MD, USA. tpawlik1@jhmi.edu.|Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA. tpawlik1@jhmi.edu.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000473:pathology* / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000556:secondary* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology*; D018365:Neoplasm, Residual; D015996:Survival Rate; D013997:Time Factors