Margin positivity after hilar resection (HR) for bile duct cancer is commonly observed due to its longitudinal spread along the subepithelial plane; nevertheless, we cannot draw conclusions regarding the prognostic effects of margins with high-grade dysplasia (HGD) or carcinoma. We aimed to investigate the oncologic effect according to the margin status after HR, particularly between the R1 HGD and the R1 carcinoma. From 2008 to 2017, 149 patients diagnosed with mid-bile duct cancer in Samsung Medical Center, South Korea, were divided according to margin status after HR and retrospectively analyzed. Recurrence patterns were also analyzed between the groups. There were 126 patients with R0 margins, nine with R1 HGD, and 14 with R1 carcinoma. The mean age of the patients was 68.3 (±8.1); most patients were male. The mean age was higher in R1 carcinoma patients than in R1 HGD and R0 patients (p= 0.014). The R1 HGD and R1 carcinoma groups had more patients with a higher T-stage than R0 (p= 0.079). In univariate analysis, the prognostic factors affecting overall survival were age, T- and N-stage, CA19-9, and margin status. The survival rate of R0 was comparable to that of R1 HGD, but the survival rate of R0 was significantly better compared to R1 carcinoma (R0 vs. R1 HGD,p= 0.215, R0 vs. R1 carcinoma,p= 0.042, respectively). The recurrence pattern between the margin groups did not differ significantly (p= 0.604). Extended surgery should be considered for R1 carcinoma; however, in R1 HGD, extended operation may not be necessary, as it may achieve oncologic outcomes similar to R0 margins with HR.
由于胆管癌沿上皮下平面纵向扩散，肝门部切除术后切缘阳性现象较为常见；然而，我们尚无法就高级别不典型增生或癌性切缘对预后的影响得出明确结论。本研究旨在探讨肝门部切除术后不同切缘状态的肿瘤学效应，特别是R1高级别不典型增生与R1癌性切缘之间的差异。本研究回顾性分析了2008年至2017年间在韩国三星医疗中心确诊的149例中段胆管癌患者，根据肝门部切除术后切缘状态进行分组。同时对各组间的复发模式进行了比较分析。结果显示：R0切缘组126例，R1高级别不典型增生组9例，R1癌性切缘组14例。患者平均年龄68.3岁（±8.1），男性居多。R1癌性切缘组患者平均年龄显著高于R1高级别不典型增生组和R0组（p=0.014）。与R0组相比，R1高级别不典型增生组和R1癌性切缘组中T分期较高的患者比例更高（p=0.079）。单因素分析显示，影响总生存期的预后因素包括年龄、T分期、N分期、CA19-9水平及切缘状态。R0组与R1高级别不典型增生组的生存率无显著差异，但R0组生存率显著优于R1癌性切缘组（R0 vs. R1高级别不典型增生，p=0.215；R0 vs. R1癌性切缘，p=0.042）。不同切缘组间的复发模式无显著差异（p=0.604）。对于R1癌性切缘患者应考虑扩大手术范围；而对于R1高级别不典型增生患者，由于通过肝门部切除术可能获得与R0切缘相似的肿瘤学结果，扩大手术范围可能并非必要。
肿瘤(癌症)患者之家