Intrahepatic cholangiocarcinoma: Ambitious operations and outcomes.

Abstract

345 Background: Data from specialized institutions suggests that resection for large ( > 7cm) and mutifocal intrahepatic cholangiocarcinoma (ICC) is safe and feasible. We aim to study this hypothesis using a population-based dataset. Methods: This is a study of a contemporary cohort from California Cancer Registry database (2004-2011) that was merged with Office of Statewide Health Planning and Development inpatient database. All patients with ICC that underwent resection or ablation were included. Tumors were classified into two groups; intrahepatic, small ( < 7cm) & solitary (ISS) vs. extrahepatic extension, large or multifocal (ELM). Mortality was recorded at 90 days. Overall survival (OS) analysis was performed using the Kaplan-Meier and Cox-proportional hazard model. Results: Of the total 275 patients that met the inclusion criteria, 55% were female, 52% were white and median age was 65 years (IQR 55-72). Majority of patients had > 3 segment resection 59% (Ablation 10%, 1-3 segments 30%). Portal lymphadenectomy was performed in 45% of patients. Vascular Invasion was found in 22% of patients, 14% were bilobar and 20% were node positive. Median follow up was 23 months (IQR 13-40). Number of ISS tumors (139, 50.5%) and ELM tumors (136, 49.5%) was similar. The two groups were comparable in regards to age, sex, race, comorbidities, extent of surgery, portal lymphadenectomy, node positivity. ELM tumors were more likely to have vessel invasion (27% vs. 17%, p = 0.048) and be bilobar (26% vs. 2%, p < 0.001). There was no significant difference in overall complication rate (ISS 34%, ELM 27%, p = 0.19) and mortality rate (both groups < 1%, p = 0.32). A multivariate Cox-proportional hazard model demonstrated that age > 60 years, > 1 comorbidity, high grade tumors, ELM tumors (HR 1.63: 95%CI 1.11-2.40; p = 0.013) and LN positivity (HR 2.30: 95%CI 1.49-3.54; p < 0.001) are independently associated with worse OS. Conclusions: Surgical resection of tumors > 7cm, multifocal lesions involving contiguous extrahepatic organs is safe with acceptable morbidity and mortality. Age > 60 years, grade, comorbidity, ELM tumors and LN positivity are independent predictors of worse OS.