Surgical Treatment Of Intrahepatic Cholangiocarcinoma Research Articles

Intrahepatic cholangiocarcinoma: risk factors affecting survival of operated patients.

The aim of this study was to evaluate the results of surgical treatment of intrahepatic cholangiocarcinoma (IHCHCA) in terms of overall survival and disease-free survival, and to analyse and find potential prognostic factors affecting overall survival and disease-free survival. Retrospective evaluation was performed of consecutively enrolled patients operated for IHCHCA from January 2005 to January 2022 (17 years) had undergone surgery. During the monitored period, 38 surgical procedures were performed, of which liver resection was done in 25 cases (65.8%). The 5-year survival in the radically resected group was 44%, and the 5-year disease-free survival was 32%. Based on univariate and multivariate analysis, radicality of surgery (p=0.01116) and lymph node involvement (p=0.00576) were assessed as negative prognostic factors for overall survival. Radicality of surgery (p=0.018) and administration of adjuvant chemotherapy (p=0.044) were significant negative prognostic factors affecting disease-free survival. However, they lost their significance in the multivariate analysis. Radical surgical resection of the liver remains an essential treatment option for intrahepatic cholangiocarcinoma aimed at achieving a radical procedure with microscopically negative margins. cholangiocarcinoma, resection, recurrence, survival.

Surgical treatment of intrahepatic cholangiocarcinoma.

Intrahepatic cholangiocarcinoma (iCCA) is a rare malignancy of the intrahepatic bile ducts. In recent years, the incidence of iCCA has increased but it is unknown to what extent this increase can be attributed to improved classification or true escalation. From a surgical perspective, though major hepatic resection has been the most appropriate treatment option for those eligible, liver transplant has recently emerged as a second surgical option for unresectable patients. However, in order for these surgical treatments to be most effective, progress is needed at all points on the patient timeline: diagnosis, selection, neoadjuvant therapy, surgery, and adjuvant therapy.

Clinical and Molecular Genetic Prognosis Factors after Surgical Treatment of Intrahepatic Cholangiocarcinoma

The aim: To study the clinical-morphological and molecular-genetic factors affecting the long-term results after surgical treatment of intrahepatic cholangiocarcinoma(ICC). Materials and Methods: Results of surgical treatment of 67 patients with ICC analyzed. The material obtained after liver resection was subjected to morphological and molecular genetic studies. The effect of tumor size, number of tumors, degree of differentiation, state of the resection margin, presence of capsule invasion, vascular invasion, the presence of metastases in regional lymph nodes on long-term results were assessed. Frequency of various mutations in ICC and their effect on long-term outcomes were assessed. In the long term, 94% of the operated patients were followed up. Results: Median overall survival was 38 months. 1-year cumulative survival rate was 71.5%, 3-year - 51.5%, 5-year - 27%. The clinical and morphological factors influencing the prognosis were the radicality of the operation (criterion R) and presence of metastases in the regional lymph nodes (log-rank, p <0.05). Frequency of gene mutations:KRAS - 27% (n = 10), IDH1/2 - 24%(n = 9), NRAS - 11% (n = 4), PIK3CA - 8%(n = 3), MET - 11%(n = 4), BRAF600 - 8%(n = 4), EGRF-4%(n = 1), ERBB2- 6% (n=2). Conclusion: The main strategy for surgical treatment of intrahepatic cholangiocarcinoma should be aggressive surgical tactics aimed at achieving R0 resection and mandatory lymphadenectomy. Mutations in a favorable prognosis are mutations in the IDH1/2 genes, mutations in the MET, PIK3CA genes are factors of an unfavorable prognosis.

Minimally invasive surgical treatment of intrahepatic cholangiocarcinoma: A systematic review.

BACKGROUNDIntrahepatic cholangiocarcinoma (ICC) is the second most common primary liver cancer and is characterized by an aggressive behavior and a dismal prognosis. Radical surgical resection represents the only potentially curative treatment. Despite the increasing acceptance of laparoscopic liver resection for surgical treatment of malignant liver diseases, its use for ICC is not commonly performed. In fact, to achieve surgical free margins a major resection and/or vascular and/or biliary reconstructions is often needed, as well as an associated lymph node dissection.AIMTo review and summarize the current evidences on the minimally invasive resection of ICC.METHODSA systematic review of the literature based on the criteria predetermined by the investigators was performed from the 1st of January 2009 up to the 1st of January 2021 in 4 databases (PubMed, Scopus, Google Scholar, and Cochrane databases). All retrospective and prospective studies reporting on the comparative outcomes of open vs minimally invasive treatment of ICC were included. An evaluation of manuscripts quality was achieved using Methodological Index for Non-Randomized Studies criteria and Newcastle-Ottawa Scale. RESULTSAfter a systematic search 9 studies fulfilled the inclusion criteria. Among the all 3012 included patients, 2450 were operated by an open approach and 562 by a minimally invasive (laparoscopic) approach. Baseline characteristics, tumor characteristics, surgical outcomes and oncological outcomes were collected and analyzed, highlighting values with a statistical significant difference between patients treated with open or laparoscopic approach. Shorter hospital stay and lower intraoperative blood losses were reported by some Authors in minimally invasive surgery, on the contrary, in the open group there was a higher number of lymphadenectomies and a higher percentage of major hepatectomies.CONCLUSIONMinimally invasive resection of ICC has some short-term benefits and it is safe and feasible only in selected centers with a high experience in laparoscopic approach for liver surgery. Minimally invasive surgery, actually, was considered mainly in patients with a tumor with a diameter < 5 cm, without invasion of main biliary duct or main vessel and no vascular or biliary reconstructions were planned. Further studies are needed to elucidate its impact on long term oncologic outcomes.

Intrahepatic cholangiocarcinoma: Prognostic factors for recurrence and survival in a series of 67 patients treated surgically at a single center

IntroductionIntrahepatic cholangiocarcinoma is a primary liver neoplasm whose only curative treatment is surgery. The objective of this study was to determine the prognostic factors for survival of intrahepatic cholangiocarcinoma treated surgically with curative intent. MethodsSixty-seven patients who had been treated surgically for this neoplasm were collected at Bellvitge University Hospital between 1996 and 2017. Epidemiological, clinical, surgical, anatomopathological, morbidity, mortality and survival data have been analysed. ResultsPostoperative study reflects our centre’s experience in the surgical treatment of intrahepatic cholangiocarcinoma over a period of 21 years. Lymphadenectomy was associated with increased morbidity, and vascular invasion in the pathological study was the most important risk factor in the survival analysis. ConclusionsThis study reflects our centre's experience in the surgical treatment of intrahepatic cholangiocarcinoma over a period of 21 years. Lymphadenectomy was associated with increased morbidity, and vascular invasion in the pathological study was the most important risk factor in the survival analysis.

Preoperative prognostic nutritional index predicts postoperative infectious complications and oncological outcomes after hepatectomy in intrahepatic cholangiocarcinoma

BackgroundIn the surgical treatment of intrahepatic cholangiocarcinoma (ICC), postoperative complications may be predictive of long-term survival. This study aimed to identify an immune-nutritional index (INI) that can be used for preoperative prediction of complications.Patients and methodsMulti-institutional data from 316 patients with ICC who had undergone surgical resection were retrospectively analysed, with a focus on various preoperative INIs.ResultsSevere complications (Clavien-Dindo grade III–V) were identified in 66 patients (20.8%), including Grade V complications in 7 patients (2.2%). Comparison of areas under the receiver operating characteristic curve (AUCs) among various INIs identified the prognostic nutritional index (PNI) as offering the highest predictive value for severe complications (AUC = 0.609, cut-off = 50, P = 0.008). Multivariate analysis revealed PNI < 50 (odds ratio [OR] = 2.22, P = 0.013), hilar lesion (OR = 2.46, P = 0.026), and long operation time (OR = 1.003, P = 0.029) as independent risk factors for severe complications. In comparing a high-PNI group (PNI ≥ 50, n = 142) and a low-PNI group (PNI < 50, n = 174), the low-PNI group showed higher rates of both major complications (27% vs. 13.4%; P = 0.003) and infectious complications (14.9% vs. 3.5%; P = 0.0021). Furthermore, median survival time and 1- and 5-year overall survival rates were 34.2 months and 77.4 and 33.8% in the low-PNI group, respectively, and 52.4 months and 89.3 and 47.5% in the high-PNI group, respectively (P = 0.0017).ConclusionPreoperative PNI appears useful as an INI correlating with postoperative severe complications and as a prognostic indicator for ICC.

Long-term results of surgical treatment for intrahepatic cholangiocarcinoma according to the tumor mutation status

Long-term results of surgical treatment for intrahepatic cholangiocarcinoma according to the tumor mutation status

Surgical Treatment of Intrahepatic Cholangiocarcinoma: Current and Emerging Principles.

Intrahepatic cholangiocarcinoma (ICC) is a rare, aggressive cancer of the biliary tract. It often presents with locally advanced or metastatic disease, but for patients with early-stage disease, surgical resection with negative margins and portahepatis lymphadenectomy is the standard of care. Recent advancements in ICC include refinement of staging, improvement in liver-directed therapies, clarification of the role of adjuvant therapy based on new randomized controlled trials, and advances in minimally invasive liver surgery. In addition, improvements in neoadjuvant strategies and surgical techniques have enabled expanded surgical indications and reduced surgical morbidity and mortality. However, recurrence rates remain high and more effective systemic therapies are still necessary to improve recurrence-free and overall survival. In this review, we focus on current and emerging surgical principals for the management of ICC including preoperative evaluation, current indications for surgery, strategies for future liver remnant augmentation, technical principles, and the role of neoadjuvant and adjuvant therapies.

Colangiocarcinoma intrahepático: factores pronósticos de recidiva y supervivencia en una serie de 67 pacientes tratados quirúrgicamente en un solo centro

IntroductionIntrahepatic cholangiocarcinoma is a primary liver neoplasm whose only curative treatment is surgery. The objective of this study was to determine the prognostic factors for survival of intrahepatic cholangiocarcinoma treated surgically with curative intent. MethodsSixty-seven patients who had been treated surgically for this neoplasm were collected at Bellvitge University Hospital between 1996 and 2017. Epidemiological, clinical, surgical, anatomopathological, morbidity, mortality and survival data have been analysed. ResultsPostoperative morbidity was 47.76%, and postoperative mortality was 1.5%. Lymphadenectomy was associated with increased morbidity. Overall survival was 91%, 49.2% and 39.8% after 12, 36 and 60 months, respectively, and disease-free survival was 67.2%, 32.8% and 22.4%. Postoperative morbidity (reoperation, vascular invasion, adjuvant chemotherapy) were shown to be factors for a poor prognosis. Vascular invasion in the pathological study was the most important risk factor in the survival analysis. ConclusionsThis study reflects our centre's experience in the surgical treatment of intrahepatic cholangiocarcinoma over a period of 21 years. Lymphadenectomy was associated with increased morbidity, and vascular invasion in the pathological study was the most important risk factor in the survival analysis.

Frequency and effects of mutations in the KRAS gene on the survival of patients after surgical treatment of intrahepatic cholangiocarcinoma

Aim. To study the effect of mutations in the KRAS gene on the clinical course of intrahepatic cholangiocellular cancer (ICC) after surgical treatment in the Russian population.Materials and methods. A molecular genetic study of tumour tissue samples from 33 patients with intrahepatic cholangiocellular cancer obtained after surgical treatment was carried out using real-time polymerase chain reaction.Results. In the Russian population, the frequency of mutations in the KRAS gene in ICC was 27%, mainly in 12 (78%), 13 (33%), 61 (55%), 117 (44%) and 146 (44%) codons of 2, 3, 4 exons. In terms of KRAS gene mutations, intrahepatic cholangiocellular cancer is characterised by a pronounced heterogeneity. As a rule, the KRAS gene demonstrates multiple mutations at several loci and co-mutations in other genes, in particular, in IDH1/IDH2, PIK3CA, NRAS and BRAF genes. KRAS gene mutations in ICC were found to be significantly more common in women. The overall survival rate was significantly higher in patients with a KRAS mutation as compared to those with the wild type of the gene. Regarding the relapse-free survival rate in the groups of patients with the mutant and wild type of the KRAS gene, no significant differences were found.Conclusion. In the Russian population, no negative association between mutations in the KRAS gene and clinical outcomes was observed.

Long-term results of surgical treatment of intrahepatic cholangiocarcinoma

To evaluate the long-term outcomes of surgical treatment of intrahepatic cholangiocarcinoma depending tumor dimensions, vascular invasion, lymph node metastases, cellular differentiation and quality of resection. There were 46 patients with intrahepatic cholangiocellular cancer. Extended hemihepatectomy was made in 14 patients (30.4%), resection of two and three liver segments - in 17 cases (36.9%), standard hemihepatectomy - in 15 patients (32.6%). Liver resection was combined with extrahepatic bile duct resection in 5 (10.9%) patients. Liver resection was followed by biopsy of specimens. Dimension and number of tumors, differentiation grade, resection margin, liver capsule invasion, vascular invasion and regional lymph node metastases were analyzed. Forty-four (95.6%) patients were followed-up in long-term postoperative period. Statistical analysis was performed using Statistica 13.2 (Dell Inc., USA) and IBM SPSS Statistics v.25 (IBM Corp., USA) software package. Survival was analyzed using the Kaplan-Meier method. Overall 1-, 3- and 5-year survival rates with two-sided 95% confidence intervals (95% CI) were calculated using IBM SPSS Statistics v.25 software. Median survival was 37 months, 1-year - 75.9% (60.9-90.9%), 3-year - 57.6% (35.5-79.6%), 5-year - 36% (8.2-63.7%). Median survival after R1 resection was 37 months, R2 resection - 12 months. Median survival was not achieved in R0 group. We found significant differences in overall survival depending on quality of resection. Tumor dimension over 5 cm, low-grade adenocarcinoma, microvascular invasion and lymph node metastases were associated with impaired postoperative survival. However, differences were not significant. The main surgical strategy in patients with intrahepatic cholangiocarcinoma should be ensuring microscopically negative resection margin.

Progress on surgical treatment of intrahepatic cholangiocarcinoma

Intrahepatic cholangiocarcinoma(ICC)is a primary liver cancer with its incidence only after hepatocellular carcinoma.Liver resection is currently the only established effective treatment for patients with ICC.However,the resectability of ICC is low and the long-term survival after surgery is far from satisfactory. With the advances in the understanding of the biological characteristics and prognostic characteristics of ICC, surgical strategy and techniques have improved in recent years, and the long-term survival has also been increased. The accurate clinical diagnosis of ICC, R0 resection, routine lymphadenectomy, effective adjuvant therapy after R0 resection, and multidisciplinary treatment including re-hepatectomy for recurrent ICC are important for achieving an optimal outcome.Down-staging management for patients with unresectable ICC may provide a chance of R0 resection in some patients. Further research on the biological heterogeneity of ICC,and the improvement of surgical treatment or the establishment of new treatment methods are the main research directions in the future.

Role of Lymph Node Dissection in Small (≤ 3 cm) Intrahepatic Cholangiocarcinoma

Background and AimsThe role of lymph node dissection (LND) in patients with small intrahepatic cholangiocarcinoma (ICC) is still under debate.The aims of this study were to compare the lymph node (LN) status and its correlation with survival among patients with ICC stratified by tumor size. MethodsA retrospective analysis of a multi-institutional series of 259 patients undergoing curative-intent surgery was carried out. Patients were stratified into Small-ICC (≤ 3 cm) and Large-ICC (> 3 cm) based on tumor size. ResultsThere were 53 and 206 patients in Small-ICC and Large-ICC groups, respectively. The incidence of LND was 62% among Small-ICC patients and 78% among Large-ICC patients (p = 0.016). LN metastases were identified in 30.3% and 38.5% of Small-ICC and Large-ICC patients, respectively (p = 0.37). No differences in terms of number of harvested LN and LN metastases were identified comparing Small- and Large-ICC patients. The 5-year overall survival (OS) was 52.6% for Small-ICC and 36.2% for Large-ICC (p = 0.024). The 5-year OS according to the LN status (N0 vs N+) was 84.8% and 36.0% (p = 0.032) in Small-ICC, and 45.7% and 12.1% in Large-ICC (p < 0.001), respectively. ConclusionWhile Small-ICC patients with no LN metastasis had a good long-term survival, the LN resulted in an important variable associated with survival also for patients in this group. Moreover, the incidence of LN metastasis did not differ when comparing Small-ICC and Large-ICC patients, suggesting that LND is mandatory in the surgical treatment of ICC regardless of tumor size.

Perihepatic lymph node dissection of resectable intrahepatic cholangiocarcinoma

Intrahepatic cholangiocarcinoma (ICC) is a primary malignant tumor derived from epithelial cell of the subbranches of the intrahepatic bile ducts, which has characteristics of atypical clinical symptom, high misdiagnosis rate and poor prognosis. Radical surgery in early stage is considered as the only effective measure to cure ICC. Nowadays, it has been a focus and still remains debatable that whether perihepatic lymph node dissection (LND) could improve the long-time survival for ICC patients in consideration of that ICC is easy to migrate via lymphatic system. Therefore, for standardization of surgical treatment of ICC and improvement of patients′ survival, it is quite important to evaluate the necessity of LND in radical resection and benefits of LND in patients highly suspected lymph node metastasis or without lymph node metastasis preoperatively and intraoperatively. Based on the current situation of the global clinical research of LND in ICC, along with the clinical practice experience in authors′ clinical center, this paper focused on the safety and effectiveness of LND aiming to provide some evidences for the indication of LND in ICC patients. Key words: Intrahepatic cholangiocarcinoma; Perihepatic lymph node dissection; Survival rate; Lymph node metastasis; Postoperative recurrence

Trends in use of lymphadenectomy in surgery with curative intent for intrahepatic cholangiocarcinoma.

The role of routine lymph node dissection (LND) in the surgical treatment of intrahepatic cholangiocarcinoma (ICC) remains controversial. The objective of this study was to investigate the trends of LND use in the surgical treatment of ICC. Patients undergoing curative intent resection for ICC in 2000-2015 were identified from an international multi-institutional database. Use of lymphadenectomy was evaluated over time and by geographical region (West versus East); LND use and final nodal status were analysed relative to AJCC T categories. Among the 1084 patients identified, half (535, 49·4 per cent) underwent concomitant hepatic resection and LND. Between 2000 and 2015, the proportion of patients undergoing LND for ICC nearly doubled: 44·4 per cent in 2000 versus 81·5 per cent in 2015 (P < 0·001). Use of LND increased over time among both Eastern and Western centres. The odds of LND was associated with the time period of surgery and the extent of the tumour/T status (referent T1a: OR 2·43 for T2, P = 0·001; OR 2·13 for T3, P = 0·016). Among the 535 patients who had LND, lymph node metastasis (LNM) was noted in 209 (39·1 per cent). Specifically, the incidence of LNM was 24 per cent in T1a disease, 22 per cent in T1b, 42·9 per cent in T2, 48 per cent in T3 and 66 per cent in T4 (P < 0·001). AJCC T3 and T4 categories, harvesting of six or more lymph nodes, and presence of satellite lesions were independently associated with LNM. The rate of LNM was high across all T categories, with one in five patients with T1 disease having nodal metastasis. The trend in increased use of LND suggests a growing adoption of AJCC recommendations in the treatment of ICC.

P-137 - Analysis of surgical treatment for intrahepatic cholangiocarcinoma

P-137 - Analysis of surgical treatment for intrahepatic cholangiocarcinoma

Minimally invasive approach to intrahepatic cholangiocarcinoma: technical notes for a safe hepatectomy and lymphadenectomy

Background: Despite the improvements of laparoscopic (LPS) technologies and their extensive application to the treatment of liver diseases, minimally invasive approach to intrahepatic cholangiocarcinoma (ICC) is still poorly widespread. The aim of the present study is to investigate the extension and the diffusion of laparoscopy applied to surgical treatment of ICC. Methods: We reviewed studies dealing with the LPS treatment of ICC and LPS lymphadenectomy (LND) for ICC. Data regarding conversion rate, morbidity and LND were extracted, synthesized and analyzed. Additionally, we described technical notes for a safe liver resection and LND. Results: We identified 11 studies encompassing liver resections for ICCs. Among a total of 1,882 cases included, there were 101 (5.5%) patients treated laparoscopically who were affected by ICC. The observed conversion rate was comparable to that of other LPS advanced procedures; laparoscopy was not responsible for increased morbidity and LND was demonstrated being feasible without causing any increasing in the post-operative complications. Furthermore, no differences in disease free survival and on the 3-year overall survival were observed. Conclusions: Few are the cases of ICC that are nowadays tackled laparoscopically. Hepatic resection and LPS LND for ICC are feasible and safe; as more, laparoscopy granted both short and long term results that were comparable to open surgery, extending the applicability of minimally invasive surgery.

Surgical treatment of intrahepatic cholangiocarcinoma: a retrospective study of 104 cases

Objective To study the clinicopathological features, surgical techniques and prognosis of patients with intrahepatic cholangiocarcinoma (ICC). Methods The data of 104 patients with ICC treated from Jan. 2008 to Dec. 2013 at the Tianjin Medical University Cancer Hospital were retrospectively reviewed. The overall survival (OS) rate and the independent risk factors related to survival were analyzed. Results The 1-, 2-, and 3-year OS rates of these patients were 72.1%, 56.1% and 43.7%, respectively, and the median survival was 34 months. The 1-, 2-, and 3-year OS rates in the hepatic hilum lymphadenectomy group were 42.9%, 28.6% and 28.6%, which were significantly lower than the non-lymphadenectomy group (78.9%, 62.5% and 47.8%). The 1-, 2-, and 3-year OS rates in the extended hepatic hilum lymphadenectomy group (75.0%, 66.7% and 33.3%) was not significantly different from the other two groups. Univariate analysis showed that age, gender, AJCC stage, differentiation, ferritin (Fer), CA19-9, CEA, lymph node metastasis and lymph node dissection were prognostic factors of long-term survival for patients with ICC (P<0.05). Multivariate analysis revealed that age, AJCC stage, differentiation, Fer, and lymph node metastasis were independent risk factors of survival (P<0.05). Conclusions Patients with ICC would not benefit from lymphadenectomy if no lymph node involvement was present. Systematic lymphadenectomy improved the outcomes of patients with lymph node metastasis. Age, AJCC stage, differentiation, Fer and lymph node metastasis were independent risk factors of survival. Key words: Intrahepatic cholangiocarcinoma; Surgical treatment; Lymph node dissection; Prognosis

Impact of lymph node status in patients with intrahepatic cholangiocarcinoma treated by major hepatectomy: a review of the National Cancer Database

IntroductionRoutine lymphadenectomy in the surgical treatment of intrahepatic cholangiocarcinoma (ICC) is not routinely performed. We aim to define predictive indicators of survival in patients with positive lymph nodes. MethodsThe National Cancer Data Base (NCDB) was queried for patients who underwent major hepatectomy for ICC between 1998 and 2011. Clinical and pathologic data were assessed using uni- and multi-variate analyses. A sub-analysis was performed on the 160 patients with positive lymph nodes. ResultsOf 849 patients with lymph node data, 57% had at least one lymph node examined. Median survival for lymph node negative patients was 37 months versus 15 months for lymph node positive patients. In lymph node positive patients, poorer survival was associated with not receiving chemotherapy (HR 1.83, p = 0.003), tumor size > 5 cm (p = 0.029), and older age (p < 0.0001). Lymph node positive patients age less than 45 had a median survival of 27 months. ConclusionsOverall survival in patients with lymph node metastases from ICC is poor. Adjuvant therapy was associated with a longer survival in lymph node positive patients, although prospective data are needed. Routine lymphadenectomy should be strongly considered to provide prognostic information and guidance for adjuvant therapy.

Surgical treatment of intrahepatic cholangiocarcinoma: A retrospective cohort study

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.