{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T16:08:41Z","timestamp":1785859721191,"version":"3.56.0"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T00:00:00Z","timestamp":1774224000000},"content-version":"vor","delay-in-days":18,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The short- and long-term outcomes of intraoperative extension of the distal bile duct margin following a positive frozen section in patients with perihilar cholangiocarcinoma remain poorly characterized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Between 1 January 2003 and 1 January 2023, consecutive patients at seven high-volume European hepatopancreatobiliary centres undergoing major hepatectomy for perihilar cholangiocarcinoma with frozen-section analysis of the distal bile duct and subsequent intraoperative management were included retrospectively. The primary endpoint was achievement of an overall R0 resection following distal bile duct re-resection or additional pancreatoduodenectomy after identification of a positive distal bile duct frozen section. Secondary endpoints included overall survival, disease-free survival, and major postoperative complications (Clavien\u2013Dindo grade \u2265 IIIa). Outcomes were reported as adjusted hazard ratios.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 785 patients undergoing major hepatectomy for perihilar cholangiocarcinoma, 594 underwent distal bile duct frozen-section analysis. A total of 66 (11.1%) intraoperative frozen sections were positive for invasive carcinoma, with an additional 7 (1.2%) false-negative findings. Distal bile duct re-resection was performed in 49 patients (74%), and 11 (16%) underwent additional pancreatoduodenectomy. Among these, 46 patients (69%) achieved distal bile duct margin clearance, with 30 (45%) ultimately attaining overall R0 resection. Overall survival was similar for patients who achieved overall R0 status via distal bile duct re-resection or pancreatoduodenectomy and those with overall R0 margins after primary negative distal bile duct frozen section (adjusted hazard ratio 0.84, 95% confidence interval 0.49 to 1.44; P = 0.536). Conversely, overall R1 resection was associated with significantly worse overall survival (adjusted hazard ratio 1.82, 1.43 to 2.33; P &amp;lt; 0.001). Complications graded \u2265 IIIa and 90-day mortality did not differ significantly between groups undergoing distal bile duct re-resection, pancreatoduodenectomy or no intervention (P = 0.126 and P = 0.121, respectively).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In selected patients, re-resection or additional pancreatoduodenectomy after positive distal bile duct frozen-section analysis is associated with long-term survival without significantly increasing major morbidity or mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjsopen\/zrag010","type":"journal-article","created":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T21:01:36Z","timestamp":1774299696000},"source":"Crossref","is-referenced-by-count":1,"title":["Clinical implications of an intraoperative margin-positive distal bile duct in perihilar cholangiocarcinoma: international multicentre cohort study"],"prefix":"10.1093","volume":"10","author":[{"given":"Hasan Ahmad","family":"Al-Saffar","sequence":"first","affiliation":[{"name":"Department of Digestive Diseases, Transplantation and General Surgery, Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Rigshospitalet , Copenhagen ,","place":["Denmark"]},{"name":"Hepatic Malignancy Surgical Research Unit (HEPSURU), Copenhagen University Hospital, Rigshospitalet , Copenhagen ,","place":["Denmark"]},{"name":"Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1515-7447","authenticated-orcid":false,"given":"Britte H E A","family":"ten Haaft","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC, University of Amsterdam , Amsterdam ,","place":["the Netherlands"]},{"name":"Cancer Center Amsterdam , Amsterdam ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Marino","sequence":"additional","affiliation":[{"name":"Hepatobiliary Surgery Division, IRCCS Ospedale San Raffaele , Milano ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7932-5921","authenticated-orcid":false,"given":"Mario","family":"De Bellis","sequence":"additional","affiliation":[{"name":"Division of General and Hepatobiliary Surgery, Department of Surgery, Dentistry, Paediatrics and Gynaecology, G. 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Rossi Hospital, University of Verona , Verona ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1691-1808","authenticated-orcid":false,"given":"Pim B","family":"Olthof","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC, University of Amsterdam , Amsterdam ,","place":["the Netherlands"]},{"name":"Department of Surgery, Erasmus MC University Medical Center , Rotterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8477-6406","authenticated-orcid":false,"given":"Sondre","family":"Busund","sequence":"additional","affiliation":[{"name":"Department of Hepatopancreatobiliary Surgery, Oslo University Hospital, University of Oslo , Oslo ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolai A","family":"Schultz","sequence":"additional","affiliation":[{"name":"Department of Digestive Diseases, Transplantation and General Surgery, Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Rigshospitalet , Copenhagen ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Gilg","sequence":"additional","affiliation":[{"name":"Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Ruzzenente","sequence":"additional","affiliation":[{"name":"Division of General and Hepatobiliary Surgery, Department of Surgery, Dentistry, Paediatrics and Gynaecology, G. 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Rossi Hospital, University of Verona , Verona ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1917-6973","authenticated-orcid":false,"given":"Bas","family":"Groot Koerkamp","sequence":"additional","affiliation":[{"name":"Department of Surgery, Erasmus MC University Medical Center , Rotterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8233-1505","authenticated-orcid":false,"given":"Joris I","family":"Erdmann","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC, University of Amsterdam , Amsterdam ,","place":["the Netherlands"]},{"name":"Cancer Center Amsterdam , Amsterdam ,","place":["The 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