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10.1245/s10434-007-9756-2
Annals of Surgical Oncology 15:807-814 (2008)
© 2008 Society of Surgical Oncology
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Original Article

An Aggressive Approach to Extrahepatic Cholangiocarcinomas Is Warranted: Margin Status Does Not Impact Survival after Resection

Jonathan Hernandez, MD, Sarah M. Cowgill, MD, Sam Al-Saadi, MD, Desiree Villadolid, MPH, Sharona Ross, MD, Emily Kraemer, Mark Shapiro, John Mullinax, BS, Jennifer Cooper, BS, Steven Goldin, MD, PhD, Emmanuel Zervos, MD and Alexander Rosemurgy, MD

Department of Surgery, University of South Florida College of Medicine, Tampa General Hospital, Room F145, 1289, Tampa, FL 33601, USA

Correspondence: Address correspondence and reprint requests to: Alexander Rosemurgy, MD; E-mail: arosemur{at}health.usf.edu

Background: With cholangiocarcinoma, the only hope of a cure is resection. This study was undertaken to determine the impact of margin status, stage, tumor location, and adjuvant therapy on survival after resection of extrahepatic cholangiocarcinoma.

Methods: From 1985–2006, 91 patients underwent resections of cholangiocarcinomas. Margin status was codified as micro-/macroscopically negative, microscopically positive/macroscopically negative, or micro-/macroscopically positive. Stage was determined using the AJCC classification (6th edition). Tumor location was classified as proximal, mid, or distal. Proximal tumors were resected by extrahepatic biliary resection with/without concomitant hepatic resection (n = 48), distal extrahepatic cholangiocarcinomas by pancreaticoduodenectomy (n = 35), and mid tumors by extrahepatic biliary resection alone (n = 8). Regression analysis and survival curve analysis were utilized. Data are presented as median, mean ± standard deviation (SD).

Results: Overall survival after resection was 21 months, 38 ± 46.0. Survival was not impacted by margin status (R0 20 months, 35 ± 45.1 versus R1 32 months, 45 ± 49.4). AJCC stage inversely correlated with survival (p = 0.004, Spearman regression analysis). Tumor location did not impact upon survival (p = 0.57, log-rank test). For proximal tumors, survival after biliary resection was significantly impacted by the need for concomitant hepatectomy (15 months, 27 ± 31.4 versus 41 months, 67 ± 17.1). Utilization of adjuvant therapy significantly improved survival (33 months, 56 ± 63.1 versus 19 months, 33 ± 40.0) (p = 0.046, Spearman regression).

Conclusions: Survival after resection of extrahepatic cholangiocarcinoma is significantly impacted by AJCC stage, the use of adjuvant therapy, and in patients with proximal tumors, the need for concomitant hepatectomy. Margin status and tumor location do not impact survival. Cholangiocarcinomas should be aggressively resected irrespective of tumor location, even if resection might result in microscopically positive margins, and adjuvant therapy applied.

Key Words: Cholangiocarcinoma • Margin status • Tumor stage • Adjuvant therapy






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