Anatomical liver resections for intrahepatic cholangiocarcinomas: Perioperative results and survival

Abstract

Presenter: Gabriela Ochoa MD | Pontificia Universidad Católica de Chile Background: Intrahepatic cholangiocarcinma (ICC) is an infrequent neoplasm, whose incidence is increasing with a poor prognosis. The only curative management is surgery, however, despite the correct selection of the cases, only 1/3 of patients achieve negative margins. We aimed to describe the experience and results in resected cases from Catholic University Hospital in Chile. Methods: Retrospective cohort analysis of the resected ICC cases with curative intention, between 2006 to 2019. The information was obtained from electronical clinical reports. The analysis was made with descriptive statistics. Results: Out of 17 patients operated for ICC. 10 were males and 7 women, between 48 and 84 years-old, 2 with risk factors (chronic liver disease, iatrogenic bile duct injury). 5 patients received neoadjuvant therapy and in 1 case portal embolization was made beforehand. 13 cases were performed open and 4 laparoscopic. There were 4 extended right hepatectomies, 3 right hepatectomies, 4 extended left hepatectomies, 3 left hepatectomies, 2 bisegmentectomies (IV, V) 1 left lateral sectionectomy. Mean operative time was 263 minutes and hospital stay average was 14,2 days. There was no 30-day mortality. The global morbidity was 41,2% (7 patients), and Clavien Dindo >IIIB complications were 17,6% (3 patients). Reoperations were performed in 2 cases, one for hemoperitoneum and the other for bile leak. The oncologic classification was Ia (1), Ib (1), II (4), IIIa (2), IIIb (8) y IV (1). There were positive lymph nodes in 8 cases and 1 patient with peritoneal metastases. 8 patients resulted R1 (47,1%). 14 patients received adjuvant treatment. The global survival was 82,4% at 6 months, 46,7% at 1 year and 40% at 2 years, with a mean follow-up of 24,3 months. Conclusion: The surgical treatment of ICC normally requires large anatomical liver resections, despite which, the incidence of R1 positive margins is high and could result in the poor prognosis of long-term disease.