Impact of Preoperative Three-Dimensional Computed Tomography Cholangiography on Postoperative Resection Margin Status in Patients Operated due to Hilar Cholangiocarcinoma

Introduction. The purpose of this study was to analyse the value of 3-dimensional computed tomography cholangiography (3D-ERC) compared to conventional retrograde cholangiography in the preoperative diagnosis of hilar cholangiocarcinoma (HC) with special regard to the resection margin status (R0/R1). Patients and Methods. All hepatic resections performed between January 2011 and November 2013 in patients with HC at the Department of General, Visceral and Transplant Surgery of the RWTH Aachen University Hospital were analysed. All patients underwent an ERC and contrast-enhanced multiphase CT scan or a 3D-ERC. Results. The patient collective was divided into two groups (group ERC: n=17 and group 3D-ERC: n=16). There were no statistically significant differences between the two groups with regard to patient characteristics or intraoperative data. Curative liver resection with R0 status was reached in 88% of patients in group ERC and 87% of patients in group 3D-ERC (p=1.00). We could not observe any differences with regard to postoperative complications, hospital stay, and mortality rate between both groups. Conclusion. Based on our findings, preoperative imaging with 3D-ERC has no benefit for operative planning and R0 resection status. It cannot replace the exploration by an experienced surgeon in a centre for hepatobiliary surgery.

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P96 THE CURRENT ROLE OF ADJUVANT THERAPY IN PATIENTS FOLLOWING NEO-ADJUVANT CHEMOTHERAPY AND R0 RESECTION FOR LOWER OESOPHAGEAL AND GOJ ADENOCARCINOMA

Diseases of the Esophagus ◽

10.1093/dote/doz092.96 ◽

2019 ◽

Vol 32 (Supplement_2) ◽

Author(s):

R Bott ◽

J Zylstra ◽

M Wilkinson ◽

W Knight ◽

C Baker ◽

...

Keyword(s):

Adjuvant Chemotherapy ◽

Adjuvant Therapy ◽

Adjuvant Treatment ◽

Survival Benefit ◽

Resection Margin ◽

Margin Status ◽

R0 Resection ◽

Resection Margin Status ◽

Neo Adjuvant Chemotherapy

Abstract Aim The aim of this study was to assess the survival benefit of adjuvant therapy in R0 resection patients following neo-adjuvant chemotherapy and surgery for lower oesophageal and GOJ adenocarcinoma. Background & Methods The role of adjuvant therapy in oesophago-gastric adenocarcinoma patients treated by neo-adjuvant chemotherapy is contentious. In UK practice surgical resection margin status is often used to stratify patients into receiving adjuvant treatment. Two prospectively collected institutional databases were combined. Patients were classified by the adjuvant therapy received. Crude and adjusted Cox regression analyses compared overall and recurrence free survival according to the adjuvant treatment, stratified by resection margin status. Recurrence patterns were assessed as a secondary outcome. Results A total of 616 patients were included (373 R0, 243 R1). In hospital mortality following surgery was 1% and these patients were excluded from analysis (n=7). In the R0 resection group 220 patients (59%) had no adjuvant treatment and 137 patients (37%) had adjuvant chemotherapy. On adjusted analysis pathological N status (p<0.0001), poor differentiation (p=0.005) and poor response to neo-adjuvant chemotherapy (p=0.001) were independently associated with poor survival. The benefit of adjuvant chemotherapy did not reach independent significance (HR 0.65 95% CI 0.40-1.06; p=0.087) compared to no treatment. However, it was observed that responders to neo-adjuvant chemotherapy (Mandard 1-3) were more likely to demonstrate a survival benefit from adjuvant chemotherapy (HR 0.42 95%CI 0.15-1.11; p=0.081) than those who are deemed to be non-responders (Mandard 4&5, HR 0.71 95%CI 0.39-1.32; p= 0.280). Conclusion Adjuvant chemotherapy may have a survival benefit in R0 resection patients following surgery, but this is likely to be limited to patients exhibiting a good response to neo-adjuvant chemotherapy.

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The Impact of Intraoperative Frozen Section on Resection Margin Status and Survival of Patients Underwent Pancreatoduodenectomy for Distal Cholangiocarcinoma

Frontiers in Oncology ◽

10.3389/fonc.2021.650585 ◽

2021 ◽

Vol 11 ◽

Author(s):

Zhiqiang Chen ◽

Bingran Yu ◽

Jiaping Bai ◽

Qiong Li ◽

Bowen Xu ◽

...

Keyword(s):

Median Survival ◽

Statistical Difference ◽

Resection Margin ◽

Frozen Section ◽

Margin Status ◽

R0 Resection ◽

Distal Cholangiocarcinoma ◽

Intraoperative Frozen Section ◽

Resection Margin Status ◽

The Impact

BackgroundIntraoperative frozen section (FS) is broadly used during pancreaticoduodenectomy (PD) to ensure a negative margin status, but its survival benefits on obtaining a secondary R0 resection for distal cholangiocarcinoma (dCCA) is controversial and unclear.MethodsClinical data of 107 patients who underwent PD for dCCA was retrospectively collected and divided into different groups based on use of FS (FS and non-FS groups) and status of resection margin (pR0, sR0 and R1 groups), and clinical parameters and survival of patients were compared and analyzed accordingly.ResultsThere were 50 patients in FS group with a median survival of 28 months, 57 patients in non-FS group with a median survival of 27 months. There was no statistical difference between the two groups with Kaplan-Meier survival analysis (P = 0.347). There were 98 patients in R0 group (88 in pR0 and 10 in sR0) and nine patients in R1 group, with a median survival of 29 months and 22 months respectively, which showed a better survival in R0 group than in R1 group (P = 0.006). Survival analyses between subgroups revealed difference between pR0 and R1 group (P = 0.005), while no statistical difference concerning pR0 vs. sR0 (P = 0.211) and sR0 vs. R1 groups (P = 0.262). Multivariate Cox regression analysis revealed resection margin status, pre-operative biliary drainage and lymph node invasion to be independent prognostic factors for dCCA patients.ConclusionsIntraoperative FS should be recommended as it significantly increased the rate of R0 resection, which was positively related to a better survival. A primary R0 resection should also be encouraged and if not, a secondary R0 could be considered at the discretion of surgeons as it showed similar survival with primary R0 resection.

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Radiomics Signatures of Computed Tomography Imaging for Predicting Resection Margin Status in Pancreatic Head Adenocarcinoma

10.21203/rs.3.rs-46691/v1 ◽

2020 ◽

Author(s):

Jinheng Liu ◽

Xubao Liu ◽

Jiajun Qiu ◽

Yanting Wang ◽

Wei Huang ◽

...

Keyword(s):

Computed Tomography ◽

Wavelet Transform ◽

Resection Margin ◽

Pancreatic Head ◽

Texture Features ◽

Margin Status ◽

Pathological Examination ◽

Gray Level ◽

Survival Prognosis ◽

Resection Margin Status

Abstract Background: To identify preoperative computed tomography radiomics texture features which correlate with resection margin status and prognosis in resected pancreatic head adenocarcinoma. Methods: Improved prognostication methods utilizing novel non-invasive radiomic techniques may accurately predict resection margin status preoperatively. In an ongoing concerning pancreatic head adenocarcinoma, the venous enhanced CT images of 86 patients who underwent pancreaticoduodenectomy were selected, and the resection margin (>1 mm or ≤1 mm) was identified by pathological examination. Three regions of interests (ROIs) were then taken from superior to inferior facing the superior mesenteric vein and artery. Subsequent Laplacian-Dirichlet based texture analysis methods extracting algorithm flows of texture features within ROIs were analyzed and assessed in relation to patient prognosis.Results: Patients with >1 mm resection margin had an overall improved survival compared to ≤1 mm (P < 0.05). Distance 1 and 2 of Gray level co-occurrence matrix, high Gray-level run emphasis of run-length matrix and average filter of wavelet transform (all P < 0.05) were correlated with resection margin status (Area under the curve was 0.784, sensitivity was 75% and specificity was 79%). The energy of wavelet transform, the measure of smoothness of histogram and the variance in 2 direction of Gabor transform are independent predictors of overall survival prognosis, independent of resection margin.Conclusions: Resection margin status (>1 mm vs ≤1 mm) is a key prognostic factor in pancreatic adenocarcinoma and CT radiomic analysis have the potential to predict resection margin status preoperatively, and the radiomic labels may improve selection neoadjucant therapy. Trial registration: Clinicaltrials.gov/ct2/show/NCT02928081.

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