The role of radial margin status in perihilar cholangiocarcinoma

A proper pathological examination of resected perihilar cholangiocarcinoma specimen should take into consideration both the ductal and the radial margin status. Unfortunately, current evidence shows that pathological reports offer a poor assessment of residual disease status, especially in Western Centers. The ambiguity in reporting on surgical margins impedes correct staging, prognosis, and the consistent design of survival studies. The present study review the Verona (Italy) experience in surgical treatment of PHCC after improved evaluation of surgical margins status and consequently investigate the impact of true R0 (negative ductal and radial margin) on survival. Radial Margin positivity was the most frequent cause of R1, and multivariable analysis identifies residual disease status as the main independent factor affecting both RFS and OS. The improved evaluation of RM status could lead to a more accurate selection of patients for adjuvant therapy.