Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. May 8, 2017; 9(13): 635-641
Published online May 8, 2017. doi: 10.4254/wjh.v9.i13.635
Importance of surgical margin in the outcomes of hepatocholangiocarcinoma
Ka Wing Ma, Kenneth Siu Ho Chok
Ka Wing Ma, Department of Surgery, Queen Mary Hospital, Hong Kong, China
Kenneth Siu Ho Chok, Department of Surgery and State Key Laboratory for Liver Research, the University of Hong Kong, Hong Kong, China
Author contributions: Ma KW designed and performed the research, conducted the statistical analysis, and wrote the manuscript; Chok KSH designed and supervised the research and provided clinical advice.
Institutional review board statement: Institutional review was not required for this retrospective study.
Informed consent statement: Informed consent to the study from patients was not required because the analysis used anonymous clinical data that were obtained after written consent to treatment had been obtained from patients.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kenneth Siu Ho Chok, MS, Associate Professor, Department of Surgery, the University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China. kennethchok@gmail.com
Telephone: +852-22553025
Received: January 20, 2017
Peer-review started: January 23, 2017
First decision: February 17, 2017
Revised: March 14, 2017
Accepted: April 6, 2017
Article in press: April 10, 2017
Published online: May 8, 2017
Processing time: 107 Days and 15.5 Hours
Abstract
AIM

To evaluate the significance of resection margin width in the management of hepatocholangiocarcinoma (HCC-CC).

METHODS

Data of consecutive patients who underwent hepatectomy for hepatic malignancies in the period from 1995 to 2014 were reviewed. Patients with pathologically confirmed HCC-CC were included for analysis. Demographic, biochemical, operative and pathological data were analyzed against survival outcomes.

RESULTS

Forty-two patients were included for analysis. The median age was 53.5 years. There were 29 males. Hepatitis B virus was identified in 73.8% of the patients. Most patients had preserved liver function. The median preoperative indocyanine green retention rate at 15 min was 10.2%. The median tumor size was 6.5 cm. Major hepatectomy was required in over 70% of the patients. Hepaticojejunostomy was performed in 6 patients. No hospital death occurred. The median hospital stay was 13 d. The median follow-up period was 32 mo. The 5-year disease-free survival and overall survival were 23.6% and 35.4% respectively. Multifocality was the only independent factor associated with disease-free survival [P < 0.001, odds ratio 4, 95% confidence interval (CI): 1.9-8.0]. In patients with multifocal tumor (n = 20), resection margin of ≥ 1 cm was associated with improved 1-year disease-free survival (40% vs 0%; log-rank, P = 0.012).

CONCLUSION

HCC-CC is a rare disease with poor prognosis. Resection margin of 1 cm or above was associated with improved survival outcome in patients with multifocal HCC-CC.

Keywords: Hepatocholangiocarcinoma; Hepatocellular cholangiocarcinoma; Survival; Hepatectomy; Resection margin

Core tip: A retrospective review of all patients who had undergone curative resection for hepatocholangiocarcinoma in the last 20 years was performed in a university center. The 5-year disease-free and overall survival were 23.6% and 35.4% respectively. Various patient and disease factors were investigated with respect to their effect to disease free and overall survival using cox regression analysis. Multifocality was the only independent factor associated with disease-free survival (P < 0.001). In a subgroup of patient (n = 20) who had multifocal tumor, resection margin of ≥ 1 cm was associated with improved 1-year disease-free survival (40% vs 0%, P = 0.012).