Published online May 8, 2017. doi: 10.4254/wjh.v9.i13.635
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
To evaluate the significance of resection margin width in the management of hepatocholangiocarcinoma (HCC-CC).
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.
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).
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.
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).