Milana Flavio, Procopio Fabio, Calafiore Eleonora, Famularo Simone, Costa Guido, Galvanin Jacopo, Branciforte Bruno, Torzilli Guido
Department of Biomedical Sciences, Humanitas University, Milan, Italy.
Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Milan, Italy.
Ann Surg Oncol. 2025 Jun;32(6):4363-4373. doi: 10.1245/s10434-025-17038-w. Epub 2025 Feb 28.
R0 resection is the standard for mass-forming cholangiocarcinoma (MFCCC). R1vasc resection (tumor-vessel detachment) yielded results comparable to R0 and superior to parenchymal-tumor exposure (R1par) for hepatocellular carcinoma and colorectal liver metastases. This study aims to clarify R1vasc outcomes for MFCCC.
Margin status of patients with MFCCC undergoing resection between 2008 and 2022 was assessed to determine the oncological efficacy of R1vasc regarding survival and hepatic recurrence.
The study analyzed 125 patients: 68 (54.4%) R0, 18 (14.4%) R1vasc, 24 (19.2%) R1par, and 15 (12.0%) R1vasc + par. Tumor size was similar between R0 (4.4 cm, range 1.5-19.0) and R1vasc (4.3 cm, range 2.3-14.5, p = 0.754) but larger for R1par (8.2 cm, range 2.5-15.0, p = 0.005) and R1vasc + par (9.0 cm, range 5.0-17.0, p < 0.001). The median overall survival (OS) was comparable for R0 [64.8 months; 95% confidence interval (CI): 50.0-79.6], R1vasc (54.4 months; 95% CI 19.6-89.2; p = 0.932), and R1vasc + par (62.0 months; 95% CI 35.6-88.5; p = 0.989). R1par showed lower OS (26.8 months; 95% CI 16.1-37.6; p = 0.134). Local recurrence was higher for R1par (45.8%, p < 0.0001) compared with R0 (10.3%) and similar for R1vasc (16.6%) and R1vasc + par (20.0%). Survival after hepatic recurrence was higher for R1vasc compared with R1par (p = 0.041).
R1vasc is a valid option for increasing resectability in patients with MFCCC, with OS being comparable to R0. R1vasc + par may be necessary for larger tumors.
R0切除是肿块型胆管癌（MFCCC）的标准治疗方式。对于肝细胞癌和结直肠癌肝转移，R1血管切除（肿瘤与血管分离）的效果与R0相当，且优于实质肿瘤暴露（R1par）。本研究旨在明确MFCCC的R1血管切除的疗效。
评估2008年至2022年间接受切除的MFCCC患者的切缘状态，以确定R1血管切除在生存和肝复发方面的肿瘤学疗效。
该研究分析了125例患者：68例（54.4%）为R0切除，18例（14.4%）为R1血管切除，24例（19.2%）为R1par切除，15例（12.0%）为R1血管切除加R1par切除。R0组（4.4 cm，范围1.5 - 19.0 cm）和R1血管切除组（4.3 cm，范围2.3 - 14.5 cm，p = 0.754）的肿瘤大小相似，但R1par组（8.2 cm，范围2.5 - 15.0 cm，p = 0.005）和R1血管切除加R1par切除组（9.0 cm，范围5.0 - 17.0 cm，p < 0.001）的肿瘤更大。R0组[64.8个月；95%置信区间（CI）：50.0 - 79.6]、R1血管切除组（54.4个月；95% CI 19.6 - 89.2；p = 0.932）和R1血管切除加R1par切除组（62.0个月；95% CI 35.6 - 88.5；p = 0.989）的中位总生存期（OS）相当。R1par组的OS较低（26.8个月；95% CI 16.1 - 37.6；p = 0.134）。与R0组（10.3%）相比，R1par组的局部复发率更高（45.8%，p < 0.0001），R1血管切除组（16.6%）和R1血管切除加R1par切除组（20.0%）的局部复发率相似。与R1par组相比，R1血管切除组肝复发后的生存率更高（p = 0.041）。
R1血管切除是提高MFCCC患者可切除性的有效选择，其OS与R0相当。对于较大肿瘤，可能需要R1血管切除加R1par切除。
