Photo Credit: adafAVCV

The following is a summary of “Status of Liver Margin in Perihilar Cholangiocarcinoma: A Multicenter Study,” published in the October 2024 issue of Surgery by Jin et al.  

The liver margin (LM) is the most significant surgical margin in resected perihilar cholangiocarcinoma (pCCA), but its status and assessment methods remain undefined.  

Researchers conducted a retrospective study exploring the prevalence and distribution of carcinoma in the LM of patients with resected pCCA.  

They analyzed 227 cases of pCCA that underwent major hepatectomy, dividing them into a discovery cohort (n=101) assessed using whole-mount digital large sections (WDLS) merged with small sections and a control cohort (n=126) estimated using only small sections.  

The results showed a resection rate of LM R1 38.6% (39/101) in the discovery cohort and 5.6% (7/126) in the control, WDLS recognized more LM R1 cases than small sections in the discovery cohort (38.6% vs. 5.9%, P<0.001). Patients with R0 resections in the discovery cohort had better overall survival (OS) and recurrence-free survival compared to those in the control cohort (both P<0.05). Furthermore, 95% of carcinoma cases were identified within 20 mm of the proximal ductal margin (DM). Proximal DM distance of less than 5 mm was a free risk factor for LM R1 resection, indicating the patients were more likely to experience R1 than those with a DM of 5 mm or greater (P<0.001).  

They concluded that positive LM status significantly contributed to R1 resection in pCCA, underscoring the importance of examining the LM within a 20 mm radius of the proximal DM.  

Source: journals.lww.com/annalsofsurgery/abstract/9900/the_status_of_liver_margin_in_perihilar.1108.aspx