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Intrahepatic cholangiocarcinoma - influence of resection margin and tumor distance to the liver capsule on survival.
BMC Surgery ( IF 1.6 ) Pub Date : 2020-04-06 , DOI: 10.1186/s12893-020-00718-7
Fabian Bartsch 1 , Janine Baumgart 1 , Maria Hoppe-Lotichius 1 , Beate K Straub 2 , Stefan Heinrich 1 , Hauke Lang 1
Affiliation  

Intrahepatic cholangiocarcinoma (ICC) is often diagnosed in advanced stage. Aim of this study was to analyse the influence of resection margins and tumor distance to the liver capsule on survival and recurrence in a single center with a high number of extended resections. From January 2008 to June 2018 data of all patients with ICC were collected and further analysed with Kaplan Meier Model, Cox regression or Chi2 test for categorical data. Out of 210 included patients 150 underwent curative intended resection (71.4%). Most patients required extended resections (n = 77; 51.3%). R0-resection was achieved in 131 patients (87.3%) with minimal distances to the resection margin > 1 cm in 22, 0.5-1 cm in 11, 0.1–0.5 cm in 49 patients, and < 0.1 cm in 49 patients. Overall survival (OS) for margins > 0.5 cm compared to 0.5–0.1 cm or R1 was better, but without reaching significance. All three groups had significantly better OS compared to the irresectable group. Recurrence-free survival (RFS) was also better in patients with a margin > 0.5 cm than in the < 0.5–0.1 cm or the R1-group, but even without reaching significance. Different distance to the liver capsule significantly affected OS, but not RFS. Wide resection margins (> 0.5 cm) should be targeted but did not show significantly better OS or RFS in a cohort with a high percentage of extended resections (> 50%). Wide margins, narrow margins and even R1 resections showed a significant benefit over the irresectable group. Therefore, extended resections should be performed, even if only narrow margins can be achieved.

中文翻译:

肝内胆管癌-切除边缘和距肝囊的肿瘤距离对存活率的影响。

肝内胆管癌(ICC)通常被诊断为晚期。这项研究的目的是分析切除边缘和距肝囊的肿瘤距离对单个中心扩大切除的存活率和复发率的影响。从2008年1月至2018年6月,收集所有ICC患者的数据,并通过Kaplan Meier模型,Cox回归或Chi2检验进一步分析分类数据。在210名患者中,有150名接受了预期的根治性切除术(占71.4%)。大多数患者需要扩大切除范围(n = 77; 51.3%)。在131例患者中实现了R0切除(87.3%),最小切除距离在22例中> 1 cm,在11例中为0.5-1 cm,49例中为0.1-0.5 cm,在49例中为<0.1 cm。边缘大于0.5厘米的总生存期(OS)比0.5-0.1厘米或R1更好,但没有意义。与不可切除的组相比,所有三个组的OS均显着提高。边缘> 0.5 cm的患者的无复发生存期(RFS)也优于<0.5-0.1 cm或R1组,但甚至没有达到显着水平。距肝囊的距离不同会显着影响OS,但不会影响RFS。应当以较宽的切除切缘(> 0.5 cm)为目标,但在延伸切除率较高(> 50%)的队列中,并不能显示明显更好的OS或RFS。较宽的切缘,较窄的切缘,甚至R1切除术均比不可切除的手术组具有明显的优势。因此,即使只能获得狭窄的切缘,也应进行扩大切除。与不可切除的组相比,所有三个组的OS均显着提高。边缘> 0.5 cm的患者的无复发生存期(RFS)也优于<0.5-0.1 cm或R1组,但甚至没有达到显着水平。距肝囊的距离不同会显着影响OS,但不会影响RFS。应当以较宽的切除切缘(> 0.5 cm)为目标,但在延伸切除率较高(> 50%)的队列中,并不能显示明显更好的OS或RFS。较宽的切缘,较窄的切缘,甚至R1切除术均比不可切除的手术组具有明显的优势。因此,即使只能获得狭窄的切缘,也应进行扩大切除。与不可切除的组相比,所有三个组的OS均显着提高。边缘> 0.5 cm的患者的无复发生存期(RFS)也优于<0.5-0.1 cm或R1组,但甚至没有达到显着水平。距肝囊的距离不同会显着影响OS,但不会影响RFS。应当以较宽的切除切缘(> 0.5 cm)为目标,但在延伸切除率较高(> 50%)的队列中,并不能显示明显更好的OS或RFS。较宽的切缘,较窄的切缘,甚至R1切除术均比不可切除的手术组具有明显的优势。因此,即使只能获得狭窄的切缘,也应进行扩大切除。但即使没有意义。距肝囊的距离不同会显着影响OS,但不会影响RFS。应当以较宽的切除切缘(> 0.5 cm)为目标,但在扩展切除率较高(> 50%)的队列中,并不能显示明显更好的OS或RFS。较宽的切缘,较窄的切缘,甚至R1切除术都比不可切除的手术组具有明显的优势。因此,即使只能获得狭窄的切缘,也应进行扩大切除。但即使没有意义。距肝囊的距离不同会显着影响OS,但不会影响RFS。应当以较宽的切除切缘(> 0.5 cm)为目标,但在具有较高比例的延伸切除(> 50%)的队列中,并未显示出明显更好的OS或RFS。较宽的切缘,较窄的切缘,甚至R1切除术均比不可切除的手术组具有明显的优势。因此,即使只能获得狭窄的切缘,也应进行扩大切除。狭窄的边缘甚至R1切除比不可切除的组有明显的好处。因此,即使只能获得狭窄的切缘,也应进行扩大切除。狭窄的边缘甚至R1切除比不可切除的组有明显的好处。因此,即使只能获得狭窄的切缘,也应进行扩大切除。
更新日期:2020-04-22
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