Abstract
Whether anatomic resection (AR) achieves better outcomes than nonanatomic resection (NAR) in patients with primary intrahepatic cholangiocarcinoma (ICC) is unclear. Data were retrieved for all consecutive patients who underwent liver resection for primary ICC from January 2007 to July 2017. The prognoses of the patients without direct invasion to contiguous organs or extrahepatic metastasis who underwent AR or NAR were compared. 85 patients underwent AR, and 65 patients underwent NAR. operation time were slightly decreased in the NAR group. The risk of Clavien-Dindo classification (CDC) IV in the AR group was significant higher than that in the NAR group. Cox regression analysis showed lymph node metastasis and adjuvant therapy were significant prognostic factors for overall survival (OS) and disease-free survival (DFS), respectively. After 1:1 propensity score matching (PSM), 29 pairs of patients were compared. The survival curves showed the NAR group had slightly improved DFS and OS than the AR group before and after matching. Thus, we conclude NAR was not inferior to AR in improving the survival outcomes for patients with primary solitary ICC lesions without direct invasion to contiguous organs or extrahepatic metastasis. Furthermore, patients may benefit from NAR.
Highlights
Intrahepatic cholangiocarcinoma (ICC) is the second most common malignant hepatic tumour and accounts for 5% to 30% of all primary liver malignancies[1,2,3,4]
Partial hepatectomy remains the mainstay of curative treatment for ICC16,17
Previous studies[8,9,10,11,12] showed the benefit of anatomic resection (AR) for single hepatocellular carcinoma (HCC) lesions. Both intrahepatic cholangiocarcinoma (ICC) and HCC arise in the hepatic parenchyma
Summary
Intrahepatic cholangiocarcinoma (ICC) is the second most common malignant hepatic tumour and accounts for 5% to 30% of all primary liver malignancies[1,2,3,4]. AR may be more effective in removing the entire tumor burden including possible satellites, nodules, as well as any high risk area of micro-portal invasion and intra-hepatic metastasis. A systematic review and meta-analysis[13] reported AR was associated with a disease-free survival (DFS) benefit at 1-, 3- and 5- years (p = 0.002, p = 0.004 and p < 0.0001, respectively) and was associated with a decreased risk of death at 5-years (p = 0.01); an original study[14] showed there was no difference in overall recurrence-free survival between the AR and NAR groups (P = 0.290). Prognoses of patients between the AR and NAR groups with primary solitary ICC lesions without direct invasion to contiguous organs or extrahepatic metastasis using a one to one propensity score matching (PSM) analysis
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