Park Su Hyung, Kim Na Reum, Kim Sung Hyun, Han Dai Hoon, Kim Kyung Sik, Choi Jin Sub, Choi Gi Hong
Department of Hepatobiliary and Pancreatic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Ann Surg Oncol. 2025 Sep 20. doi: 10.1245/s10434-025-18142-7.
This study aimed to redefine resection margin classification by considering the clearance length and high-grade dysplasia of the margin, as well as to evaluate the association between adjuvant radiotherapy and recurrence patterns.
The study retrospectively analyzed 218 patients who underwent curative-intent resection between 2012 and 2022. Resection margins were categorized as wide-clear (>2 mm), narrow-clear (≤2 mm or clear margin after re-resection), dysplastic, or invasive. Recurrence patterns and the effect of adjuvant radiotherapy on local recurrence-free survival were assessed across these margin groups.
Overall recurrence occurred for 62.1% of the patients. The local recurrence rates per margin were as follows: wide-clear (23.6%), narrow-clear (32.6%), dysplastic (35.3%), and invasive (31.4%). The patients receiving adjuvant radiotherapy had a significantly lower local recurrence (adjusted hazard ratio [HR], 0.097; 95% confidence interval CI 0.033-0.286; p < 0.001). Notably, no local recurrence was observed in patients from the wide-clear, narrow-clear, or dysplastic groups who received adjuvant radiotherapy. In the invasive-margin group, the patients who received adjuvant radiotherapy had a lower risk of local recurrence (adjusted HR 0.04; 95% CI 0.01-0.24; p < 0.01).
The refined margin classification showed distinct recurrence patterns. Adjuvant radiotherapy was associated with local recurrence in patients with invasive margins and in those with dysplastic or narrow-clear margins, including cases with R0 status achieved through re-resection. More tailored postoperative strategies that incorporate the margin status might help to address recurrence risk of hilar cholangiocarcinoma.
