Intrahepatic cholangiocarcinoma - Influence of postoperative morbidity on long-term outcome

Abstract

Introduction: Intrahepatic cholangiocarcinoma (ICC) has a late onset of symptoms and is therefore often diagnosed in advanced stage. Often major or extended resections are necessary for complete tumor clearance which leads to higher rates of morbidity and mortality. Aim was to analyse its influence on long-term outcome. Methods: All consecutive explorations for ICC were collected in a prospective database between 2008 to June 2018 for further analyses. Survival was analysed using Kaplan Meier model and log rang test. Morbidity was classified regarding the Dindo-Clavien classification. Results: In total 210 patients underwent exploration with 150 resections (71.4%). We performed 77 extended resections with a comparable number of major (n=36) and minor resections (n=37). No morbidity occurred in 81 patients (54%) with a proportion of grade I or II of 17 (11.3%). 39 patients suffered from major complications (26%; grade IIIa n=28, IIIb n=3, IVa n=6, IVb n=2). Thirteen patients died postoperatively (8.7%). Median overall survival (OS) for no morbidity, grade I+II or III+IV groups was 24.3, 21.6 and 23.8 months, respectively. 1-, 3- and 5-year OS was 81%, 29% and 15% for no morbidity, 88%, 32% and 5% for grade I+II and 71%, 38% and 29% for grade III+IV, respectively and not statistically different (p=0.633, Figure A). Median recurrence-free survival (RFS) was 9.9, 8.3 and 9.8 months for no morbidity, grade I+II or III+IV groups. 1-, 3- and 5-year RFS 39%, 15% and 11% for no morbidity, 27%, 7 % and 0% for grade I+II and 39%, 23% and 19% for grade III+IV, respectively and not statistically different (p=0.385, Figure B). Conclusion: Postoperative morbidity has neither influence on overall survival nor recurrence-free survival in patients who underwent resection for intrahepatic cholangiocarcinoma. Interestingly the grade III + IV group had a slightly better long-term outcome for OS and RFS.