The impact of resection margin status according to lymph node metastasis on the survival outcome of perihilar cholangiocarcinoma

Abstract

Background

The prognostic factors for overall survival (OS) in perihilar cholangiocarcinoma (pCCA) included resection margin (RM) and lymph node metastases (LNM). Nevertheless, the advantage associated with a negative RM in patients with LNM remains unresolved.

Methods

The study retrospectively analyzed patients with pCCA underwent curative-intent resection between October 2013 and December 2018. The evaluation of the OS was conducted based on the presence of LNM and the status of RM.

Results

Of the 167 resected pCCA patients, 87 (52.1 ​%) were LNM negative, and 80 (47.9 ​%) were LNM positive. Of the 87 LNM-negative patients, 68 (78.2 ​%) were R0 resections, and 19 (21.8 ​%) were R1 resections. In LNM-negative patients, the OS was longer in the R0 resection than the R1 resection group (median survival time (MST) of 32.1 vs 15.7 months, respectively; p ​< ​0.001). Of the 80 LNM-positive patients, 35 were R0 resections and 45 were R1 resections. Among patients with LNM positivity, the OS rates were similar between the groups who underwent R1 resection and R0 resection (MST of 8.4 vs 8.0 months, respectively; p ​= ​0.109).

Conclusion

In patients with pCCA, the RM status was the most important prognostic factor for LNM-negative patients. However, there was no impact in LNM-positive patients.