Clinical value of additional resection of a margin-positive proximal bile duct in hilar cholangiocarcinoma

BackgroundBased on frozen section examination, additional resection of the proximal bile duct was performed to achieve a negative margin at the time of resection of hilar cholangiocarcinoma. The aim of this study was to determine whether additional resection of a margin-positive proximal duct can improve survival.MethodsThe records of 303 resected patients with hilar cholangiocarcinoma were reviewed, focusing on the status of the proximal ductal margin.ResultsFrozen section examination of the proximal ductal margin was carried out in 138 of the 303 patients included in this study. The histopathologic diagnosis was negative in 110 patients, positive with carcinoma in situ in 11, and positive with invasive cancer in 17. In the 17 patients with invasive cancer, additional resection was performed in 12. The length of resection was ≤ 5 mm in all patients. With additional resection, a negative margin was achieved in 8 patients. The survival rate for patients in whom a negative margin was achieved after additional resection (n = 8) was worse than that for patients with a negative margin or a positive with carcinoma in situ margin (n = 275) and was similar to that for patients with a positive margin with invasive cancer (n = 20).ConclusionAdditional resection of >5 mm in the proximal duct is difficult after maximal or near-maximal resection of the duct. Such limited resection of a margin-positive proximal duct does not improve survival, even when a negative margin can be achieved with additional resection.