Surgical treatment of intrahepatic cholangiocarcinoma: A retrospective cohort study

Abstract

BackgroundIntrahepatic cholangiocarcinoma (IHCC) is the second most frequently developed primary carcinoma of liver, after hepatocellular carcinoma (HCC). They are biologically aggressive and they are frequently discovered in late study. Surgical removal is the only curative therapeutic method for treatment of such tumors. Patients and methodsFrom 1.1.2004 to 31.12.2014, at the Department of Surgery, University Hospital Martin and Jessenius Medical Faculty of Comenius University in Martin, we operated 411 patients with benign, primary, metastatic tumors of liver, where in 33 patients (8%) the histology confirmed the primary intrahepatic cholangiocarcinoma of liver. In the group, we evaluated the 1-year and 5-year survival of the patients according to radical resections, the degree of differentiation of tumor (grading), and according to positivity of lymph node. The results were statistically analyzed by the Student t-test and Kaplan–Meier curves of survival. ResultsThe average age of the patients was 59.6 ± 11.4 years, the males represented 46.2%, the females represented 53.8%. The average age of males was 58 ± 13.2, and females 61 ± 9.8 years. Large anatomic resections of 3 and more segments of liver were performed in 24 patients, anatomic resections and metastasectomies were performed in 6 patients, two patients had radiofrequency ablation of tumor. R0 resection was achieved in 20 patients, R1 resection in 8 patients, and R2 resection in 5 patients. One-year survival in the R0 group was 65%, in the R1 group 62%, and in the R2 resections group it was only 20%; five-year survival after R0 resections was 52%, and in R1 and R2 it was zero, which proved to be statistically significant. The median of survival in R0 resections was 12 months (interval 1–87 months), in R1 resections it was 12 months (interval 1–36 months), and after R2 resections it was 7 months (interval 1–12 months). One-year and five-year survival, depending on the degree of differentiation, was statistically non-significant; however, the five-year survival of G1 tumors is on the level of being statistically significant – the 5-year survival expressed in percentage G1/G2/G3 was 50%/12%/0% respectively. Positive lymph nodes were found in 16 patients (48%) from the group of 33 patients. The one-year and five-year survival was not statistically significant; however, 5 years of survival was recorded in 30% patients with negative lymph node and 0% patients with positivity of lymph node. ConclusionResection of tumor is the optional method; it should be attempted to achieve R0 resection and at the same time to preserve sufficient volume of residual functional parenchyma. Radical R0 resection is considered by us as the only possible method of surgical treatment for survival of patients with IHCC.