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Background <p>This study aimed to redefine resection margin classification by considering the clearance length and high-grade dysplasia of the margin, as well as to evaluate the association between adjuvant radiotherapy and recurrence patterns.</p> Methods <p>The study retrospectively analyzed 218 patients who underwent curative-intent resection between 2012 and 2022. Resection margins were categorized as wide-clear (&gt;2&#xa0;mm), narrow-clear (≤2&#xa0;mm or clear margin after re-resection), dysplastic, or invasive. Recurrence patterns and the effect of adjuvant radiotherapy on local recurrence-free survival were assessed across these margin groups.</p> Results <p>Overall recurrence occurred for 62.1% of the patients. The local recurrence rates per margin were as follows: wide-clear (23.6%), narrow-clear (32.6%), dysplastic (35.3%), and invasive (31.4%). The patients receiving adjuvant radiotherapy had a significantly lower local recurrence (adjusted hazard ratio [HR], 0.097; 95% confidence interval CI 0.033–0.286; <i>p</i> &lt; 0.001). Notably, no local recurrence was observed in patients from the wide-clear, narrow-clear, or dysplastic groups who received adjuvant radiotherapy. In the invasive-margin group, the patients who received adjuvant radiotherapy had a lower risk of local recurrence (adjusted HR 0.04; 95% CI 0.01–0.24; <i>p</i> &lt; 0.01).</p> Conclusions <p>The refined margin classification showed distinct recurrence patterns. Adjuvant radiotherapy was associated with local recurrence in patients with invasive margins and in those with dysplastic or narrow-clear margins, including cases with R0 status achieved through re-resection.&#xa0;More tailored postoperative strategies that incorporate the margin status might help to address recurrence risk of hilar cholangiocarcinoma.</p>

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Redefining Resection Margin Status and Its Implications for Adjuvant Radiotherapy in Hilar Cholangiocarcinoma: A 10-Year Retrospective Study of Recurrence Patterns

  • 期刊论文

  • 发表日期：

    2025年9月20日

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  • Su Hyung Park,
  • Na Reum Kim,
  • Sung Hyun Kim,
  • Dai Hoon Han,
  • Kyung Sik Kim,
  • Jin Sub Choi,
  • Gi Hong Choi

摘要

Background

This study aimed to redefine resection margin classification by considering the clearance length and high-grade dysplasia of the margin, as well as to evaluate the association between adjuvant radiotherapy and recurrence patterns.

Methods

The study retrospectively analyzed 218 patients who underwent curative-intent resection between 2012 and 2022. Resection margins were categorized as wide-clear (>2 mm), narrow-clear (≤2 mm or clear margin after re-resection), dysplastic, or invasive. Recurrence patterns and the effect of adjuvant radiotherapy on local recurrence-free survival were assessed across these margin groups.

Results

Overall recurrence occurred for 62.1% of the patients. The local recurrence rates per margin were as follows: wide-clear (23.6%), narrow-clear (32.6%), dysplastic (35.3%), and invasive (31.4%). The patients receiving adjuvant radiotherapy had a significantly lower local recurrence (adjusted hazard ratio [HR], 0.097; 95% confidence interval CI 0.033–0.286; p < 0.001). Notably, no local recurrence was observed in patients from the wide-clear, narrow-clear, or dysplastic groups who received adjuvant radiotherapy. In the invasive-margin group, the patients who received adjuvant radiotherapy had a lower risk of local recurrence (adjusted HR 0.04; 95% CI 0.01–0.24; p < 0.01).

Conclusions

The refined margin classification showed distinct recurrence patterns. Adjuvant radiotherapy was associated with local recurrence in patients with invasive margins and in those with dysplastic or narrow-clear margins, including cases with R0 status achieved through re-resection. More tailored postoperative strategies that incorporate the margin status might help to address recurrence risk of hilar cholangiocarcinoma.