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RADIAL MARGIN POSITIVITY FAVORS LOCAL RECURRENCE AND SHORTENS RECURRENCE-FREE SURVIVAL IN PERI-HILAR CHOLANGIOCARCINOMA
Mario De Bellis
*, Laura Alaimo, Edoardo Poletto, Simone Conci, Marzia Tripepi, Tommaso Campagnaro, Andrea Ruzzenente
Universita degli Studi di Verona, Verona, Veneto, Italy
BackgroundMost patients with peri-hilar cholangiocarcinoma (PHCC) have a recurrence within the first few years after curative-intent surgery. Local recurrence is more frequently observed in patients with positive surgical margins. A proper assessment of surgical margins should take into consideration both ductal (DM) and radial margin (RM) status. DM positivity is uncommon since it can be assesses intraoperatively at frozen section and, if needed, additional resection can be performed. Instead, RM positivity is the main cause of R1 resection for anatomical and technical reason.
ObjectiveThe aim of this study is to correlate RM with the pattern and timing of recurrence.
MethodsFrom 2014 to 2020, 90 patients underwent curative surgery for PHCC at Verona University Hospital, Verona, Italy. DM (proximal and distal biliary margin) and RM (hepatic, periductal, and vascular margin) status were reviewed by expert hepatobiliary pathologists. Patients with lymph-node metastases and/or R1 resection were candidate to adjuvant treatment. Surveillance was performed with contrast-enhanced CT every 4-6 months. Recurrence was classified as local, distant, or intrahepatic. Local recurrence was defined as any recurrence at the hepatic transection plane, hepaticojejunostomy, distal bile duct remnant, or elsewhere in the liver hilum.
ResultsR1 resections were 54% (N=49). DM positivity was 27% (N=24) and RM positivity was 48% (N=43). 60% (N=54) of patients had a recurrence in a median follow up time of 41 months (IQR, 10-55). Local recurrence was observed in 39% (N=21) of patients and was the most common pattern of recurrence. RM positivity was significantly associated with local recurrence (p<0.05). On logistic regression analysis RM positivity resulted a risk factor for local recurrence (p<0.037; OR 3.93; 95% CI 1.09-14.2). The 1-year recurrence-free survival of patients with positive RM was shorter than in patients with negative RM (53% versus 73%, p<0.031). Multivariable analysis identified RM as independent prognostic factor of recurrence-free survival (p<0.037; HR 1.80, 95% CI 1.04–3.12).
ConclusionRM positivity favors local recurrence and shortens recurrence-free survival. R1 resection offers a rationale for the administration of adjuvant therapy.
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