Department of Hepatobiliary Surgery, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, AP-HP, Université Paris 7, Clichy, France.
Ann Surg. 2011 Nov;254(5):824-29; discussion 830. doi: 10.1097/SLA.0b013e318236c21d.
Define the optimal surgical margin in patients undergoing surgery for intrahepatic cholangiocarcinoma (IHCC).
Surgery is the most effective treatment for IHCC. However, the influence of R1 resection on outcome is controversial and that of margin width has not been evaluated.
We studied 212 patients undergoing curative resection of mass-forming-type IHCC. The respective influences on survival of resection status (R0 vs R1), surgical margin width, pTNM stage, and the latter's components were evaluated.
Incidence of R1 resection was 24%. Overall, R1 resection was not an independent predictor of survival [odds ratio (OR) 1.2 (0.7-2.1)] in contrast to the pTNM stage [OR 2.10 (1.2-3.5)]. In the 78 pN+ patients, survival was similar after R0 and R1 resections (median: 18 vs 13 months, respectively, P = 0.1). In the 134 pN0 patients, R1 resection was an independent predictor of poor survival [OR 9.6 (4.5-20.4)], as was the presence of satellite nodules [OR 1.9 (1.1-3.2)]. In the 116 pN0 patients with R0 resections, median survival was correlated with margin width (≤1 mm: 15 months; 2-4 mm: 36 months; 5-9 mm: 57 month; ≥10 mm: 64 month, P < 0.001) and a margin >5 mm was an independent predictor of survival [OR 2.22 (1.59-3.09)].
Patients undergoing surgery for IHCC are at high risk of R1 resections. In pN0 patients, R1 resection is the strongest independent predictor of poor outcome and a margin of at least 5 mm should be created. The survival benefits of resection in pN+ patients and R1 resection in general are very low.
确定肝内胆管细胞癌（intrahepatic cholangiocarcinoma，IHCC）患者手术中最佳的手术切缘。
手术是治疗 IHCC 最有效的方法。然而，R1 切除对预后的影响仍存在争议，而切缘宽度的影响尚未得到评估。
我们研究了 212 例行肿块型 IHCC 根治性切除术的患者。评估了切除状态（R0 与 R1）、手术切缘宽度、pTNM 分期及其组成部分对生存的各自影响。
R1 切除的发生率为 24%。整体而言，与 pTNM 分期相比（OR 2.10[1.2-3.5]），R1 切除不是生存的独立预测因素（OR 1.2[0.7-2.1]）。在 78 例 pN+患者中，R0 与 R1 切除后的生存情况相似（中位生存时间：分别为 18 个月和 13 个月，P=0.1）。在 134 例 pN0 患者中，R1 切除是生存较差的独立预测因素（OR 9.6[4.5-20.4]），卫星结节的存在也是如此（OR 1.9[1.1-3.2]）。在 116 例接受 R0 切除的 pN0 患者中，中位生存时间与切缘宽度相关（≤1mm：15 个月；2-4mm：36 个月；5-9mm：57 个月；≥10mm：64 个月，P<0.001），且切缘>5mm 是生存的独立预测因素（OR 2.22[1.59-3.09]）。
接受 IHCC 手术的患者 R1 切除的风险较高。在 pN0 患者中，R1 切除是预后不良的最强独立预测因素，应创建至少 5mm 的切缘。pN+患者的手术切除和总体上的 R1 切除的生存获益非常低。
