Survival Outcomes and Prognostic Factors of Surgical Therapy for All Potentially Resectable Intrahepatic Cholangiocarcinoma: a Large Single-Center Cohort Study

Abstract

BackgroundSurgical resection is currently indicated for all potentially resectable intrahepatic cholangiocarcinoma (ICC), but the survival outcomes and the prognostic factors have not been well-documented due to its rarity. This study aims to assess these in a large, consecutive series of patients with ICC treated surgically. MethodsA retrospective study was conducted on 1,333 ICC patients undergoing surgery between January 2007 and December 2011. Surgical results and survival were evaluated and compared among different subgroups of patients. Univariate and multivariate analyses were performed to identify prognostic factors. ResultsR0, R1, R2 resection and exploratory laparotomy were obtained in 34.8, 44.9, 16.4, and 3.9 % of the patients, respectively. The overall 1-, 3-, and 5-year survival rates for the entire cohort were 58.2, 25.2, and 17.0 %, respectively, with corresponding rates of 79.1, 42.6, and 28.7 % for patients with R0 resection; 60.5, 20.1, and 13.9 % for patients with R1 resection; 20.5, 7.4, and 0 % for patients with R2 resection; and 3.8, 0, and 0 % for patients with an exploratory laparotomy. Independent factors for poor survival included positive resection margin, lymph node metastasis, multiple tumors, vascular invasion, and elevated CA19-9 and/or CEA, whereas hepatitis B virus infection and cirrhosis were independently favorable prognosis indicators. ConclusionsR0 resection offers the best possibility of long-term survival, but the chance of a R0 resection is low when surgery is performed for potential resectable ICC. Further randomized trials are warranted to refine indications for surgery in the management of ICC.