| Background and aim Positive surgical status(R1)is closely related to the tumor recurrence and has been widely accepted as one of the prognositic risk factors for intrahepatic cholangiocarcinoma(ICC)after hepatectomy by hepatic surgeons.More large multiinstitutional studies inclined to increase the negative margin width to improve prognosis.However,other different point of views declared that as long as to achieve negative resection margin,the margin width did no influence prognosis after liver resection.When the ICC with liver cirrhosis,wide resection margin may affect postoperative liver function,even cause liver failure and death.Hepatic surgeon likely to be more conservatively under this circumstance when hepatectomy.There is no research of the margin width in the ICC with cirrhosis group.Furthermore,the role of adjuvant chemotherapy in patients with ICC undergoing curative-intent resection remains poorly understood.We sought to study the effectiveness of margin width and the adjuvant transarterial chemoembolization(TACE)on the prognostic of patients undergoing resection for ICC with hepatitis B virus(HBV)-related cirrhosis.Patients and Methods Establish a strictly enroll and exclusion criteria,retrospectively collected a total of 306 ICC with HBV-related cirrhosis patients who underwent hepatic resection with macroscopically complete resection between July 2004 and June 2013 in the study.Tumor recurrence rate using the chi-square test or Fisher's exact test.Tumor recurrencefree survival(RFS)and overall survival(OS)using the Kaplan-Meier survival curves and Log-Rank test comparison,respectively.COX proportional hazards models to analysis influence of independent risk factors in tumor RFS and OS.Results R1 resection was found in 39(12.7%)patients;among patients who underwent negative margin resection(R0),margin width was divided into wide margin group(?10 mm)in 80(26.2%)patients and narrow margin group(1-9 mm)in 187(61.1%)patients.During follow-up period,recurrence occured in 209 cases,including 29 cases in R1 group,accounting for 74.4% of R1 group,180 cases in R0 group,accounting for 67.4% of R0 group.Early recurrence rate was higher in R1 group than in R0 group(P = 0.045),but there was no difference between the wide and narrow margin groups(P = 0.603).R1 group had higher intrahepatic recurrence rate(P = 0.023)and marginal recurrence rate(P < 0.001)than R0 group,however there was no difference between the wide and narrow margin groups(P = 0.371,0.376,respectively).The incidence of postoperative complications had no difference between the wide and narrow margin groups,including liver insufficiency/liver failure,bile leakage,infections,etc.The overall median and 1-,3-,5-years of RFS and OS 13.8 months,52%,31%,24% and 21.3 months,63%,36%,28%,respectively.The median and 1-,3-,5-years of RFS and OS in R1 resection was 8.8 months,32%,9%,0% and 11.7 months,49%,13%,0%,respectively.Patients who had an R1 resection had an inferior RFS(risk ratio [HR] 2.090,95% confidence interval [CI],1.298 to 3.366,P = 0.002)and OS(HR 1.872,95% CI 1.193 2.938,P = 0.006).The median and 1-,3-,5-years of RFS and OS in narrow margin group was 13.6 months,52%,30%,21% and 22.0 months,65%,38%,31%,respectively.The median and 1-,3-,5-years of RFS and OS in wide margin group was 20.8 months,61%,41%,33% and 30.7 months,68%,46%,37%,respectively.Narrow margin group had a worse RFS(HR 1.451,95% CI 1.048 2.010,P = 0.025)compare to wide margin group,but no difference in the OS(HR 1.209,95% CI 0.872 1.676,P = 0.254).TACE had no effect on RFS(P = 0.075)and OS(P = 0.080)in the whole cohort.The median and 1-,3-,5-years of RFS and OS in narrow margin group with TACE was 20.8 months,62%,37%,25% and 30.7 months,73%,44%,36%,respectively.The median and 1-,3-,5-years of RFS and OS in narrow margin group without TACE was 11.5 months,46%,26%,18% and 19.8 months,61%,35%,29%,respectively.TACE can improved RFS(P = 0.032)and OS(P = 0.049)in the narrow margin group,however,TACE had no effect for R1 and wide margin group.Conclusions R1 resection has an unfavorable effect on RFS and OS in ICC with HBV-related cirrhosis patients undergoing hepatectomy.Also has higher intrahepatic recurrence rate and marginal recurrence rate than R0 group.Wide margin has no effect on the OS but on the RFS,which does not increase the incidence of postoperative complications.Hepatic surgeons should make the greatest efforts for achieving more than 10 mm margin width when hepatictomy.If wide margin resection cannot be done,TACE may provide an effective option for the narrow margin group. |
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