Surgical Resection Of Intrahepatic Cholangiocarcinoma Research Articles

Current Practice and Outcomes of Patients undergoing Surgical Resection for Intrahepatic Cholangiocarcinoma: A Real-world, Multicentre Cohort Study

Current Practice and Outcomes of Patients undergoing Surgical Resection for Intrahepatic Cholangiocarcinoma: A Real-world, Multicentre Cohort Study

Oncological Outcome after Surgical Resection for Intrahepatic Cholangiocarcinoma Can Be Predicted Based on Radiological Features

Introduction: Preoperative patient selection is crucial in intrahepatic cholangiocarcinoma (iCCA) as high rates of recurrence and dismal oncological outcome is observerd after surgical resection.Therefore, we aimed to identify characteristics with prognostic value focusing on preoperative radiological features. Method: A cohort of 139 patients who underwent hepatectomy for iCCA between 2010 and 2020 at University Hospital, RWTH Aachen were eligible for this study. Kaplan–Meier and Cox regressions were used for survival analysis and associations of overall survival (OS) and recurrence-free survival (RFS) with clinical/radiological characteristics, respectively. Results: Based on radiological features patients were stratified into three groups: single nodule ≤ 3 cm, single nodule > 3 cm, and ≥ 2 nodules. Oncological analysis revealed a mean OS of 142 months in individuals with a single nodule ≤ 3 cm, median OS of 28 months with a single nodule > 3 cm, and 19 months with ≥ 2 nodules, respectively. Multivariable analyses based on preoperative characteristics showed the radiological stratification to be independently associated with OS (HR (hazard ratio) = 4.25 (1 nodule, > 3 cm), HR = 5.97 (≥ 2 nodules), p = 0.011), RFS (HR = 4.18 (1 nodule, > 3 cm), and HR = 11.07 (≥2 nodules), p = 0.001). Conclusions: Patients with single iCCA ≤ 3 cm show compelling OS and RFS. Basic radiological features (e.g., nodule size, number) are prognostic for patients undergoing surgery and useful in preoperative patient selection.

Minimally Invasive Surgery for Intrahepatic Cholangiocarcinoma: Patient Selection and Special Considerations.

Intrahepatic cholangiocarcinoma (ICC) is an aggressive primary hepatic malignancy. Unfortunately, despite advancements in diagnosis, staging and management, mortality is high. Surgery remains the only curative treatment, but many patients present with advanced, unresectable disease. For patients able to undergo surgical resection, overall survival is improved, but remains low, with high rates of disease recurrence. Minimally invasive surgery (MIS), including laparoscopic and robotic approaches, are increasingly used in surgical resection for ICC. These approaches variably demonstrate faster recovery times, less blood loss, decreased postoperative pain and fewer postoperative complications, with adequate oncologic resections. This review examines patient selection and special considerations for MIS for ICC. Patient selection is critical and includes evaluation of a patient’s anatomic and oncologic resectability, as well as comorbidities.

Abstract 353: The translocations of FGFR2 and NTRK1 in intrahepatic cholangiocarcinoma and their discordance in status by FISH and IHC

Abstract Objectives Intrahepatic cholangiocarcinoma(ICC) is a subtype of primary liver cancer lacking effective therapeutic agents. Chromosomal translocations of the neurotrophic tyrosine receptor kinase (NTRK) and fibroblast growth factor receptor 2 (FGFR2) have become promising therapeutic targets in several kinds of malignancies, but their incidence and optimum testing standards have not been fully assessed in ICC. The current study investigated the status of FGFR2 and NTRK1 genes in ICCs by different methods, and their correlation with clinicopathological features. Methods We examined FGFR2 and NTRK protein expression by immunohistochemistry (IHC), FGFR2 and NTRK1 gene translocation by fluorescence in situ hybridization (FISH). Samples were collected from 160 patients who underwent surgical resection for ICC. Break-apart probes were employed and the ratios of FGFR2 or NTRK1/chromosome enumeration probe (CEP) 10 double-color probes were determined. Furthermore, we analyzed the clinicopathological significances of the patients. Results FGFR2-positive status was detected in 13.2% of ICCs. Twenty-one patients (13.2%) were detected FGFR2 translocation. Compared with the patients with normal FGFR2, FGFR2-positivity tended to correlate with low histological grade, less mucus(P=0.024), and lower preoperative serum CA199 level, showed(P<0.01)in certain tumors, and were accompanied by hepatitis B virus infection more frequently (P<0.01). Histologically, tumors with FGFR2 translocation had a tendency to manifest small-duct subtype. The Kaplan-Meier survival analysis showed that patients with FGFR2 translocation had better prognosis in 5-year survival than those with normal FGFR2 (P=0.007),( median overall survival, 57 months vs 33 months). With regard to the NTRK1 translocated ICCs, 5.6% (9/160) were detected to have NTRK1 translocation, 5 cases were female, 4 were with hepatitis B virus infection, and 6 showed histologically large-duct subtype. Interestingly, two patients demonstrated both FGFR2 and NTRK1 translocation by FISH. However, among the 9 cases with NTRK1 translocation, only 2 cases showed moderately positive on IHC, with the remaining 7 cases weak or negative. Similarly, only 14.3% (3/21) FGFR2 translocation FISH-positive cases showed moderate to strong positive by IHC. Concordance rates between IHC and FISH were 22.2% for NTRK1 and 14.3% for FGFR2. The positive rate by IHC is significantly lower than that by FISH on both NTRK1 (2.5% vs 5%) and FGFR2 (3.7% vs 13%) according to our cohort. Conclusions The positive rate by IHC is significantly lower than that by FISH on both genes. The findings of this study suggest that a large subgroup of FGFR2-positive and NTRK-positive cases can be considered for targeted therapy. Moreover, the FGFR2 and NTRK status in ICCs should be determined carefully using a sensitive approach toward larger cancer tissues. Citation Format: Yining Zou, Yuan Ji. The translocations of FGFR2 and NTRK1 in intrahepatic cholangiocarcinoma and their discordance in status by FISH and IHC [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 353.

Prognostic value of resection margin length after surgical resection for intrahepatic cholangiocarcinoma

BackgroundThe definition and prognostic value of a wide resection margin remains controversial. The aim of this study was to assess the relevance of resection margin length for survival following intrahepatic cholangiocarcinoma (ICC) resection. MethodsPatients scheduled for curative resection for ICC between 2015 and 2018 were identified from an institutional database. Demographic data, pathological margin length, and oncologic outcomes were collected and analyzed. ResultsThis study included 126 patients, of whom 78% underwent anatomical hepatectomy. The resection margin was <0.5, <1.0, and <1.5 cm in 73 (60%), 92 (73%), and 109 (87%) patients, respectively. A resection margin ≥1.0 cm was associated with favorable overall survival (OS) (HR: 0.403; 95% CI: 0.191–0.854; P = 0.018) and recurrence-free survival (RFS) (HR: 0.436; 95% CI: 0.232–0.817; P = 0.010). In the anatomical hepatectomy group, a resection margin ≥1.0 cm was an independent predictor of superior OS (HR: 0.451; 95% CI: 0.208–0.977; P = 0.043) and RFS (HR: 0.470; 95% CI: 0.242–0.914; P = 0.026). ConclusionsA resection margin ≥1.0 cm was associated with significantly improved survival in ICC. Therefore, a clear margin of at least 1.0 cm should be achieved during ICC resection.

Does resection improve overall survival for intrahepatic cholangiocarcinoma with nodal metastases?

BackgroundThe potential benefit of surgical resection of intrahepatic cholangiocarcinoma in patients with locoregionally advanced disease has not been definitively determined. MethodsThe National Cancer Database was queried to identify patients with clinical evidence of node-positive intrahepatic cholangiocarcinoma. Resected patients were stratified by margin status and lymph node ratio (nodes positive to nodes harvested). Risk of death was determined using Cox regression models and Kaplan-Meier survival functions. ResultsA total of 1,425 patients with T(any)N1M0 intrahepatic cholangiocarcinoma were identified. Two hundred twelve (14.9%) underwent surgical resection. On multivariable Cox regression, R0 resection afforded a survival benefit regardless of lymph node ratio (lymph node ratio > 0.5: hazard ratio 0.466, 95% confidence interval 0.304–0.715; lymph node ratio ≤ 0.5: hazard ratio 0.444, 95% confidence interval 0.322–0.611), whereas a survival benefit was only seen in R1 patients with lymph node ratio ≤ 0.5 (hazard ratio 0.470, 95% confidence interval 0.316–0.701). On Kaplan-Meier, median survival was 11.6 months with chemotherapy, 15.7 months with R0 resection in lymph node ratio > 0.5, and 22.2 months with R0 resection in lymph node ratio ≤ 0.5 (P < .001). DiscussionMargin negative resection is associated with a risk-adjusted survival benefit for patients with clinically N1 intrahepatic cholangiocarcinoma regardless of the degree of regional lymph node involvement.

Clinical exploration of laparoscopic liver resection for intrahepatic cholangiocarcinoma of 58 cases

Objective To explore the safety and feasibility of laparoscopic liver resection in the treatment of intrahepatic cholangiocarcinoma (ICC). Methods The retrospective study was adopted. The clinical data of 58 patients with ICC who underwent laparoscopic liver resection in the Department of Hepatobiliary Minimally Invasive Surgery of the First Affiliated Hospital of Hu′nan Normal University were collected From January 2016 to December 2018. Among them, 34 patients were males and 24 were females, aged from 34 to 71 years with a median age of 54 years. Observation indicators: (1) Surgical treatment: surgical methods, operation time, intraoperative blood loss, intraoperative blood transfusion rate, intraoperative hepatic portal blocking time, conversion rate, postoperative complications, postoperative hospital stay. (2) Postoperative pathological conditions. (3) Follow-up.Follow-up visits were conducted using an outpatient clinic and telephone to understand patient survival after surgery. The follow-up period was until June 2019. Measurement data with normal distribution were expressed as (Mean±SD), count data was expressed as frequency and percentage. Results A total of 58 patients were included in this study, of which 48 patients underwent laparoscopic radical surgical resection of intrahepatic cholangiocarcinoma and 10 patients underwent laparoscopic conversion to laparotomy. (1) Surgical treatment: laparoscopic resection of the left liver (segments Ⅱ, Ⅲ and Ⅳ), laparoscopic resection of the right liver (segments Ⅴ, Ⅵ, Ⅶ and Ⅷ), laparoscopic resection of the right posterior lobe (segments Ⅵ and Ⅶ), laparoscopic extended resection of the right posterior lobe, laparoscopic resection of the middle lobe (Ⅳ, Ⅴ and Ⅷ), laparoscopic resection of the V and Ⅵ, laparoscopic resection of the left liver (segments Ⅱ, Ⅲ and Ⅳ) combined with the caudate lobe (segments I and Ⅸ), laparoscopic extended left hemihepatectomy, laparoscopic resection of the VI, laparoscopic resection of the Ⅶ and Ⅷ, laparoscopic resection of the left lateral lobe (segments Ⅱ and Ⅲ) and laparoscopic resection of the right hepatic mass; operation time: (320.38±107.68) min; intraoperative blood loss: (262.34±76.06); intraoperative blood loss: 0 (0/58); Intraoperative hepatic portal occlusion time: (48±15) min, the conversion rate was 17.2% (10/58); the incidence of postoperative biliary fistula was 6.8% (4/58), and the patient was discharged after conservative treatment and unobstructed drainage (T-tube vacuum suction); the postoperative gastrointestinal recovery time was (1.84±0.57) d; no other serious complications occurred.Postoperative hospital stay: (9.34±3.39) d; there were no deaths and unplanned surgeries during the perioperative period. (2) Pathological conditions: 32 cases received lymph node dissection during the operation, and 26 cases showed cholangiocarcinoma without lymph node dissection; pathological examination showed that the pathological reports of all tumor margins were negative, and 4 cases showed lymph node dissection and positive lymph node metastasis. (3) Follow-up results: of the 58 patients with ICC, 49 were followed up for 6 to 36 months. The tumor survival time was (4 to 36) months. 28 patients survived without tumor. 17 patients had intrahepatic metastasis with multiple lymph node metastasis. 4 patients were treated with microwave ablation after intrahepatic metastasis was found. 9 patients were lost to follow-up. Conclusion Laparoscopic treatment of intrahepatic cholangiocarcinoma is safe and feasible in experienced centers. Key words: Laparoscopic; Liver resection; Cholangiocarcinoma

Highlights of This Issue

A metalloendopeptidase, nardilysin (NRDC), has been suggested to play important roles in inflammation and several cancer types. Yoh and colleagues explored the feasibility of serum NRDC as a prognostic biomarker in patients undergoing surgical resection for intrahepatic cholangiocarcinoma (ICC), the second-most common primary liver cancer with high metastatic rate. As a result, high NRDC levels were associated with poorer prognosis. Serum NRDC levels also were correlated with epithelial mesenchymal transition-related genes in primary tumors. Together, serum NRDC can be a clinically relevant tool for predicting the postoperative outcomes of ICC and therefore contribute to develop a treatment strategy.Up to 50,000 thyroidectomies are performed unnecessarily in the United States annually due to the inability to diagnose benign versus cancerous thyroid nodules. By using genome wide DNA methylation analysis of 109 thyroid tissues, Yim and colleagues found that benign nodules differ from adjacent thyroid tissues and malignant nodules. By using tissue specific epigenetic patterns for benign and malignant thyroid nodules, the authors developed a highly accurate thyroid cancer diagnostic test with an estimated 97% PPV and 100% NPV. Thus, a tissue-specific DNA methylation approach has the potential to provide standard-of-care cancer diagnoses for thyroid nodules.The cellular adhesion molecule VCAM-1 is upregulated on vascular endothelial cells in disease. Using mouse models of brain metastases, Cheng and colleagues show that vascular VCAM-1 is expressed early following metastatic seeding in the brain across a number of different tumor types. Moreover, an MR imaging probe targeted to VCAM-1 enabled detection of micrometastatic deposits that were undetectable using the standard clinical diagnostic method of gadolinium-enhanced MRI. This VCAM-1-targeted MRI approach has the potential to drastically alter the management of patients at risk of brain metastasis in existing treatment paradigms and will lead to greater personalization of care.SGK1 is a conserved member of the AG family of serine/threonine kinases that is highly expressed at the tops of intestinal crypts, suggesting a role in differentiation. SGK1 expression is often reduced in colorectal cancer, with poorly differentiated tumors resulting in a worse prognosis. To explore its role in differentiation, Lee and colleagues conducted a multiomics approach to demonstrate that SGK1 re-expression directly promotes the differentiation of colorectal cancer cells, while inhibiting metastatic potential in a mouse orthotopic xenograft model. This work proposes a greater focus upon therapeutic agents that promote tumor differentiation, rather than simply targeting cell survival, for future research.

A Case of Solitary Paraaortic Lymph Node Recurrence after Surgical Resection for Intrahepatic Cholangiocarcinoma

A Case of Solitary Paraaortic Lymph Node Recurrence after Surgical Resection for Intrahepatic Cholangiocarcinoma

Oncologic impact of lymph node dissection for intrahepatic cholangiocarcinoma: a propensity score-matched study

Background Intrahepatic cholangiocarcinoma is a malignancy of the intrahepatic biliary tree. Although surgical resection is the mainstay of treatment for this tumor, the impact of lymph node dissection during hepatectomy is controversial. In this study, we evaluated the impact of lymph node dissection during surgical resection for intrahepatic cholangiocarcinoma. Methods Records from 170 patients who underwent radical hepatectomy for intrahepatic cholangiocarcinoma from January 2000 to December 2014 were retrospectively reviewed. Twenty-two patients who underwent R1 resection or had distant metastasis at the time of surgery were excluded. Using propensity score matching (matched factors: differentiation, lymphovascular invasion, perineural invasion, and T stage), the patients were divided into two groups: no dissection (n = 34) or lymph node dissection (n = 34). Disease-free survival and overall survival were compared between groups. Results There was a marginally significant difference between the two groups with respect to the disease-free survival (no dissection vs. lymph node dissection: 20.0 [4.2-35.8] months vs. 64.0 [27.3-120.8] months, p = 0.077). Overall survival was significantly longer in the lymph node dissection group (no dissection vs. lymph node dissection: 44.0 [31.1-56.9] months vs. 90.0 [51.1-158.9] months, p = 0.027). Conclusion Radical surgery including an adequate lymph node dissection area and suitable harvested lymph nodes appears to improve oncologic outcomes for intrahepatic cholangiocarcinoma.

Oncologic Impact of Lymph Node Dissection for Intrahepatic Cholangiocarcinoma: a Propensity Score-Matched Study

BackgroundIntrahepatic cholangiocarcinoma is a malignancy of the intrahepatic biliary tree. Although surgical resection is the mainstay of treatment for this tumor, the impact of lymph node dissection during hepatectomy is controversial. In this study, we evaluated the impact of lymph node dissection during surgical resection for intrahepatic cholangiocarcinoma. MethodsRecords from 170 patients who underwent radical hepatectomy for intrahepatic cholangiocarcinoma from January 2000 to December 2014 were retrospectively reviewed. Twenty-two patients who underwent R1 resection or had distant metastasis at the time of surgery were excluded. Using propensity score matching (matched factors: differentiation, lymphovascular invasion, perineural invasion, and T stage), the patients were divided into two groups: no dissection (n = 34) or lymph node dissection (n = 34). Disease-free survival and overall survival were compared between groups. ResultsThere was a marginally significant difference between the two groups with respect to the disease-free survival (no dissection vs. lymph node dissection: 20.0 [4.2–35.8] months vs. 64.0 [27.3–120.8] months, p = 0.077). Overall survival was significantly longer in the lymph node dissection group (no dissection vs. lymph node dissection: 44.0 [31.1–56.9] months vs. 90.0 [51.1–158.9] months, p = 0.027). ConclusionRadical surgery including an adequate lymph node dissection area and suitable harvested lymph nodes appears to improve oncologic outcomes for intrahepatic cholangiocarcinoma.

Impaction of surgical margin status on the survival outcome after surgical resection of intrahepatic cholangiocarcinoma: a systematic review and meta-analysis

BackgroundConflicting results about the prognostic value of surgical margin status in patients with intrahepatic cholangiocarcinoma (ICC) have been reported. We aimed to assess the association between surgical margin status and prognosis in ICC through a meta-analysis. Materials and methodsWe conducted a literature search of the articles evaluating the prognostic value of surgical margin status in patients with ICC. The pooled estimation of the hazard ratio (HR) with the 95% confidence interval (CI) was performed to determine the influence of surgical margin status on the survival outcome. ResultsA total of 21 studies involving 3201 patients were finally included into the meta-analysis. The percentage of patients with positive surgical margin ranged from 7.2% to 75.9% in the enrolled studies. The pooled estimates showed that patients with positive surgical margin had inferior overall survival (HR: 1.864; 95% CI: 1.542–2.252; P < 0.001) and progression-free survival (HR: 2.033; 95% CI: 1.030–4.011; P = 0.041) than patients with negative ones. The subgroup analyses and sensitivity analyses were consistent with the overall results. ConclusionsPatients with negative surgical margin had significantly favorable overall survival and progression-free survival after surgical resection for ICC. The notion of achieving the R0 resection should be emphasized.

Model to predict survival after surgical resection of intrahepatic cholangiocarcinoma: the Mayo Clinic experience

BackgroundThe 7th edition of the American Joint Committee on Cancer (AJCC) staging system has recently been validated and shown to predict survival in patients with intrahepatic cholangiocarcinoma (ICC). The present study attempted to investigate the validity of these findings. MethodsA single‐centre, retrospective cohort study was conducted. Histopathological restaging of disease subsequent to primary surgical resection was carried out in all consecutive ICC patients. Overall survival was compared using Kaplan–Meier estimates and log‐rank tests. ResultsA total of 150 patients underwent surgery, 126 (84%) of whom met the present study's inclusion criteria. Of these 126 patients, 68 (54%) were female. The median length of follow‐up was 4.5 years. The median patient age was 58 years (range: 24–79 years). Median body mass index was 27 kg/m2 (range: 17–46 kg/m2). Staging according to the AJCC 7th edition categorized 33 (26%) patients with stage I disease, 27 (21%) with stage II disease, five (4%) with stage III disease, and 61 (48%) with stage IVa disease. The AJCC 7th edition failed to accurately stratify survival in the current cohort; analysis revealed significantly worse survival in those with microvascular invasion, tumour size of >5 cm, grade 4 disease, multiple tumours and positive lymph nodes (P < 0.001). A negative resection margin was associated with improved survival (P < 0.001). ConclusionsThe AJCC 7th edition did not accurately predict survival in patients with ICC. A multivariable model including tumour size and differentiation in addition to the criteria used in the AJCC 7th edition may offer a more accurate method of predicting survival in patients with ICC.

Prognostic factors after surgical resection for intrahepatic cholangiocarcinoma

Objective To identify the prognostic factors for patients with intrahepatic cholangiocarcinoma.Methods The clinical data of 99 patients with intrahepatic cholangiocarcinoma who received surgical treatment at the Cancer Hospital of Tianjin Medical University from January 2000 to January 2010 were analyzed retrospectively.Lymph nodes at the hepatic portal and group 12,13 and 8 lymph nodes were resected.The range of hepatectomy was decided according to the size,location,number of tumor and the hepatic function.Patients were followed up every month within the first 6 months after operation,every 3 months at 6 months later,and they were followed up every half year at 2 years later.Patients who were suspected as with tumor recurrence or progression were followed up every month.All the patients were followed up till death or March of 2013.The survival was analyzed using the Log-rank test,and multivariate analysis was done using the COX regression model.Results Forty patients received hemi-hepatectomy,27 received extended hemi-hepatectomy,20 received segmentectomy,and 12 received hemi-hepatectomy + wedge resection.All the patients were followed up and the median time of follow-up was 33 months (range 21.1-44.9 months).The 1-,3-,5-year recurrence-free survival rates and total survival rates of the 99 patients were 64.6％,29.2％,22.7％ and 78.8％,46.4％ and 30.3％,respectively.The results of univariate analysis showed that hepatitis B or C virus infection,preoperative CA19-9 level,TNM staging,lymph node metastasis,microvascular invasion,number of nodules and Ro resection were risk factors influencing the recurrence-free survival time (Log-rank value =5.048,5.982,20.128,13.148,29.632,32.488,50.574,P ＜0.05).The peroperative CA19-9 level,TNM staging,lymph node metastasis,microvascular invasion,number of nodules and R0 resection were risk factors influencing the total survival rate (Log-rank value =4.302,17.267,11.756,23.840,36.411,47.126,P ＜0.05).There were significant differences in the recurrence-free survival time and total survival time between patients in different TNM stages (20 patients in stage Ⅰ,44 in stage Ⅱ,8 in stage Ⅲ and 27 in stage Ⅳ) (Log-rank value =20.128,17.267,P ＜0.05).There were significant difference in the recurrence-free survival time between patients in stage Ⅰ and Ⅲ,patients in stage Ⅰ and Ⅳ,and between patients in stage Ⅱ and Ⅳ (Log-rank value =10.807,19.368,6.347,P ＜ 0.05).There were significant difference in the total survival time between patients in stage Ⅰ and Ⅱ,patients in stage Ⅰ and Ⅲ,patients in stage Ⅰ and Ⅳ and between patients in stage Ⅱ and Ⅳ (Log-rank value =6.119,4.015,16.282,4.929,P＜0.05).There was no significant difference in the survival time between patients in other TNM stages (P ＞ 0.05).The results of multivariate analysis showed that TNM stage Ⅲ and Ⅳ,microvascular invasion,multiple nodules and R0 resection were independent risk factors influencing the recurrence-free survival time (RR =1.413,3.073,2.737,3.916,95％ confidence interval:1.119-1.784,1.837-5.140,1.338-4.207,1.849-8.291,P＜0.05) ; lymph node metastasis,microvascular invasion,multiple tumors and R0 resection were the independent risk factors influencing the total survival time (RR =2.025,2.948,0.327,3.494,95％ confidence interval:1.215-3.374,1.774-4.900,0.183-0.583,1.670-7.310,P ＜ 0.05).Conclusions TNM stage Ⅲ and Ⅳ,lymph node metastasis,microvascular invasion,multiple nodules,non-R0 resection shorten the recurrence-free survival time and total survival time of patients who received surgical resection for intrahepatic cholangiocarcinoma,and they are the main factors influencing the prognosis.R0 resection could improve the survival of patients with intrahepatic cholangiocarcinoma. Key words: Liver neoplasms; Lymph node metastasis; Microvascular invasion; Multiple noducles; R0 resection

Resection and reconstruction of suprahepatic IVC and right atrium for invasive intrahepatic cholangiocarcinoma

Surgical resection of intrahepatic cholangiocarcinoma with major vascular and atrial invasion is described in this case report using cardiopulmonary bypass followed by complex vascular reconstruction.

Late recurrence after resection of mass-forming intrahepatic cholangiocarcinoma: report of a case

The outcome after surgical resection for intrahepatic cholangiocarcinoma has not been satisfactorily evaluated due to its malignant behavior. Surgical resection, however, has the potential to improve the prognosis and may allow surgeons to experience rare cases with long survival. This report presents the case of a patient who developed recurrence 9 years after resection of intrahepatic cholangiocarcinoma. A 76-year-old female was diagnosed to have intrahepatic cholangiocarcinoma and underwent an extended right posterior subsegmentectomy. The gross appearance showed a mass-forming type tumor. The histopathological examination revealed well to moderately differentiated adenocarcinoma associated with portal vein invasion. Subcutaneous metastasis in the head as the first sign of relapse was diagnosed 9 years after hepatectomy. The histopathological findings of the subcutaneous tumor were similar to those of the intrahepatic cholangiocarcinoma, thus suggesting metastasis from intrahepatic cholangiocarcinoma. Positron emission tomography with 2-[fluorine-18]-fluoro-2-deoxy-D-glucose was useful for detecting multiple metastases. Long-term follow-up for more than 5 years is recommended because the present case shows that late recurrence of intrahepatic cholangiocarcinoma occurs even 5 years after resection.

Extended Liver Resection for Intrahepatic Cholangiocarcinoma

The present study was conducted to analyze the outcome after liver resection for intrahepatic cholangiocarcinoma (IHC) and to compare the prognostic accuracy of the fifth and sixth editions of the TNM classification of malignant tumors. A comparison of the prognostic accuracy of the fifth and sixth editions of the TNM classification of malignant tumors is missing for IHC as yet. The present report is, to our knowledge, the largest series on surgical resection of IHC in the world literature and the first comparison of long-term outcome according to the fifth and sixth edition of the TNM classification of malignant tumors. From 1988 to 2007, 195 liver resections for IHC were performed in our institution. Staging was performed according to the liver chapters of the fifth and sixth edition of the TNM classification of malignant tumors. In a multivariate analysis of prognostic variables, R0-resection, UICC-stage I/II according to the sixth edition, highly or moderately differentiated IHC, and lymph node negative IHC were identified as favorable prognostic variables. UICC-stage IIIc of the sixth edition, which was almost identical to the group of lymph node positive IHC was identified as unfavorable predictor of postoperative prognosis. Formally, curative resections (R0-resections) were achieved in 138 patients (71%). One- and 5-year survival rates after R0-resections were 72.4% and 30.4%, respectively. Extended resections for IHC resulted in a favorable rate of R0-resection, which is the most important prognostic variable. Staging of IHC according to sixth edition of the TNM classification is superior in comparison with the fifth edition as indicated by the results of the multivariate analysis.

Surgical Outcome and Prognostic Factors in Intrahepatic Cholangiocarcinoma

The clinicopathologic features and surgical outcome of intrahepatic cholangiocarcinoma are not fully understood. Fifty-six consecutive patients with intrahepatic cholangiocarcinoma who underwent surgical resection at the National Cancer Center Hospital East between October 1992 and July 2007 were retrospectively analyzed. Intrahepatic cholangiocarcinomas were subdivided into solitary tumors and tumors with intrahepatic metastasis. Complete tumor removal (R0 resection) was performed in 42 patients (75%). The 5-year survival rate for patients with intrahepatic cholangiocarcinoma (n = 56), patients with a solitary tumor (n = 46), and patients with intrahepatic metastasis (n = 10) were 32, 38, and 0%, respectively. There was a significant difference in survival between patients with a solitary tumor and those with intrahepatic metastasis (p < 0.0001). The 5-year survival rate for patients with stage I (n = 3), II (n = 9), III (n = 15), and IV disease (n = 26) was 100, 67, 37, and 0%, respectively. There was a significant difference in survival between stage I and stage IV (p = 0.011), between stage II and stage IV (p = 0.0002), and between stage III and stage IV (p = 0.0015). The most frequent site of recurrence was the liver. Univariate analysis showed that intrahepatic metastasis, portal vein invasion, hepatic duct invasion, lymph node metastasis, perineural invasion, and positive surgical margin (R1) were significantly associated with poor survival. Multivariate analysis confirmed that intrahepatic metastasis was a significant and independent prognostic indicator after surgical resection for intrahepatic cholangiocarcinoma (p = 0.001). No patient with intrahepatic metastasis survived more than 10 months in this study. Intrahepatic metastasis was the strongest predictor of poor survival in intrahepatic cholangiocarcinoma.

Recurrence after surgical resection of intrahepatic cholangiocarcinoma.

We aimed to assess the patterns of recurrence after surgery for intrahepatic cholangiocarcinoma (ICC) and the outcomes of treatment in patients with recurrence. From 1981 to 1999, 123 patients with ICC underwent hepatectomy. The 3-year and 5-year survival rates were significantly higher in patients after curative resection (n = 56; 53%, 50%) than in patients after noncurative resection (n = 67; 7%, 2%; P < 0.0001). In 54 patients followed-up after curative resection, the rate of recurrence after surgery was 46%. The recurrences were in the liver (56%), abdomen (disseminated; 24%), and lymph nodes (20%). The rates of recurrence were significantly higher in patients with various classifications of mass-forming ICC tumors (P = 0.039) than in those with other types of tumors, and in patients with tumors over 3 cm in greatest diameter than in those with tumors 3 cm or less (P = 0.006). Hepatic recurrence, abdominal dissemination, and intraductal recurrence were significantly related to tumors that included mass-forming ICC (P = 0.002), tumors that included periductal infiltrating ICC (P = 0.009), and tumors that included intraductal growth ICC (P = 0.038), respectively. Seven patients with recurrence underwent radiation, chemotherapy, immunotherapy, or surgical resection. Only 2 patients, with intrahepatic metastasis and intraductal recurrence, respectively, had good outcomes after surgery. The effectiveness of other treatments has not been established.