Negative resection was associated with improved clinical outcomes in patients with resectable intrahepatic and extrahepatic hilar cholangiocarcinoma (CCA), a study published in the journal Surgery found.

Patients with CCA who underwent negative resections had longer median overall survival rates (24.5 ± 0.02 vs 19.1 ± 0.02 months) than those who underwent positive resections (P <.01). The rates of 5-year overall survival were also higher in the negative resection cohort (24.5% vs 16.7%).

Most (83.4%, n=3018) participants of the study underwent negative resections. In addition to the positive impact on overall survival, patients in the negative resection cohort were less likely to have stage 3 disease (16.7% vs 25.7%) and to receive adjuvant radiation (27.1% vs 45.7%) and chemotherapy (49.4% vs 61.0%).

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They also presented with smaller tumors (2.97 ± 0.07 cm vs 3.49 ± 0.15 cm) when compared to patients in the positive resection cohort.

“These findings suggest that more extensive resections to clear the tumor margin are justified in patients generally fit for such procedures,” the authors said.

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However, the authors also acknowledged that their analysis had several limitations. They performed a retrospective review of the National Cancer Database to select patients, therefore subjected their findings to inherent selection and omitted variable biases.

Also, the authors matched negative and positive resection cohorts for the disease stage, but the database misses important information, including data on the locoregional extent of tumor invasions, the extent of resections, complications, postoperative functional health, and disease recurrences.

“It is important to realize that margin of resection may in fact not be a determinate of long-term clinical outcome but rather reflect cancer biology and simply an important prognostic indicator,” they said.


Littau MJ, Kim P, Kulshrestha S, et al. Resectable intrahepatic and hilar cholangiocarcinoma: is margin status associated with survival? Surgery. Published online December 4, 2021. doi:10.1016/j.surg.2021.09.038