| Title |
The Impact of Intraoperative Re-Resection of a Positive Bile Duct Margin on Clinical Outcomes for Hilar Cholangiocarcinoma
|
|---|---|
| Published in |
Annals of Surgical Oncology, February 2018
|
| DOI | 10.1245/s10434-018-6382-0 |
| Pubmed ID | |
| Authors |
Xu-Feng Zhang, Malcolm H. Squires, Fabio Bagante, Cecilia G. Ethun, Ahmed Salem, Sharon M. Weber, Thuy Tran, George Poultsides, Andre Y. Son, Ioannis Hatzaras, Linda Jin, Ryan C. Fields, Matthew Weiss, Charles Scoggins, Robert C. G. Martin, Chelsea A. Isom, Kamron Idrees, Harveshp D. Mogal, Perry Shen, Shishir K. Maithel, Carl R. Schmidt, Timothy M. Pawlik |
| Abstract |
The impact of re-resection of a positive intraoperative bile duct margin on clinical outcomes for resectable hilar cholangiocarcinoma (HCCA) remains controversial. We sought to define the impact of re-resection of an initially positive frozen-section bile duct margin on outcomes of patients undergoing surgery for HCCA. Patients who underwent curative-intent resection for HCCA between 2000 and 2014 were identified at 10 hepatobiliary centers. Short- and long-term outcomes were analyzed among patients stratified by margin status. Among 215 (83.7%) patients who underwent frozen-section evaluation of the bile duct, 80 (37.2%) patients had a positive (R1) ductal margin, 58 (72.5%) underwent re-resection, and 29 ultimately had a secondary negative margin (secondary R0). There was no difference in morbidity, 30-day mortality, and length of stay among patients who had primary R0, secondary R0, and R1 resection (all p > 0.10). Median and 5-year survival were 22.3 months and 23.3%, respectively, among patients who had a primary R0 resection compared with 18.5 months and 7.9%, respectively, for patients with an R1 resection (p = 0.08). In contrast, among patients who had a secondary R0 margin with re-resection of the bile duct margin, median and 5-year survival were 30.6 months and 44.3%, respectively, which was comparable to patients with a primary R0 margin (p = 0.804). On multivariable analysis, R1 margin resection was associated with decreased survival (R1: hazard ratio [HR] 1.3, 95% confidence interval [CI] 1.0-1.7; p = 0.027), but secondary R0 resection was associated with comparable long-term outcomes as primary R0 resection (HR 0.9, 95% CI 0.4-2.3; p = 0.829). Additional resection of a positive frozen-section ductal margin to achieve R0 resection was associated with improved long-term outcomes following curative-intent resection of HCCA. |
X Demographics
The data shown below were collected from the profiles of 14 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United States | 6 | 43% |
| Ireland | 1 | 7% |
| Italy | 1 | 7% |
| Spain | 1 | 7% |
| Mexico | 1 | 7% |
| Unknown | 4 | 29% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 9 | 64% |
| Practitioners (doctors, other healthcare professionals) | 3 | 21% |
| Scientists | 1 | 7% |
| Science communicators (journalists, bloggers, editors) | 1 | 7% |
Mendeley readers
The data shown below were compiled from readership statistics for 25 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 25 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Researcher | 8 | 32% |
| Other | 3 | 12% |
| Student > Doctoral Student | 2 | 8% |
| Student > Postgraduate | 2 | 8% |
| Student > Master | 1 | 4% |
| Other | 2 | 8% |
| Unknown | 7 | 28% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 14 | 56% |
| Biochemistry, Genetics and Molecular Biology | 1 | 4% |
| Agricultural and Biological Sciences | 1 | 4% |
| Business, Management and Accounting | 1 | 4% |
| Social Sciences | 1 | 4% |
| Other | 1 | 4% |
| Unknown | 6 | 24% |
Attention Score in Context
This research output has an Altmetric Attention Score of 8. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 20 May 2018.
All research outputs
#4,494,569
of 24,615,420 outputs
Outputs from Annals of Surgical Oncology
#1,366
of 6,963 outputs
Outputs of similar age
#82,896
of 335,565 outputs
Outputs of similar age from Annals of Surgical Oncology
#27
of 99 outputs
Altmetric has tracked 24,615,420 research outputs across all sources so far. Compared to these this one has done well and is in the 81st percentile: it's in the top 25% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 6,963 research outputs from this source. They typically receive a little more attention than average, with a mean Attention Score of 6.6. This one has done well, scoring higher than 80% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 335,565 tracked outputs that were published within six weeks on either side of this one in any source. This one has done well, scoring higher than 75% of its contemporaries.
We're also able to compare this research output to 99 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 72% of its contemporaries.