Is Surgical Resection Justified for Advanced Intrahepatic Cholangiocarcinoma?

Abstract

Backgrounds: Prognosis for patients with advanced intrahepatic cholangiocarcinoma (ICC) with intrahepatic metastasis (IM), vascular invasion (VI), or regional lymph node metastasis (LM) remains poor. The aim of this study was to clarify the indications for surgical resection for advanced ICC. Methods: We retrospectively divided 213 ICC patients treated at Kyoto University Hospital between 1993 and 2013 into a resection (n=164) group and a non-resection (n=49) group. Overall survival was assessed after stratification for the presence of IM, VI, or LM. Results: Overall median survival times (MSTs) for the resection and non-resection groups were 26.0 and 7.1 months, respectively (p<0.001). After stratification, MSTs in the resection and non-resection groups, respectively, were 18.7 vs. 7.0 months for patients with IM (p<0.001), 23.4 vs. 5.7 months for those with VI (p<0.001), and 12.8 vs. 5.5 months for those with LM (p<0.001). Conclusion: When macroscopic curative resection is possible, surgical resection can be justified for some advanced ICC patients with IM, VI, or LM.

Impact of major vascular resection on outcomes and survival in patients with intrahepatic cholangiocarcinoma: A multi‐institutional analysis

“…In some instances, the ICC mass may involve a major vascular structure such as the PV or ICC. Data on the perioperative and long‐term outcomes of patients undergoing ICC resection with a concurrent major vascular resection are limited, with most previous studies being small, single center experiences . The current study is important because we examined outcomes of patients with ICC who underwent resection with concomitant major vascular resection using a large international multi‐institutional database.…”

“…Intrahepatic cholangiocarcinoma (ICC) is an aggressive primary hepatic tumor. Though rare, recent reports have suggested that the incidence and mortality associated with ICC have increased dramatically in the United States with similar trends worldwide . Unfortunately, many patients with ICC present with advanced disease and less than 40% of patients are candidates for resection .…”

“…Resection of the portal vein (PV) or inferior vena cava (IVC) have traditionally been considered a relative contraindication to resection of ICC. More recently, however, several studies have highlighted the feasibility, safety, and possible oncologic benefit of concomitant vascular resection for ICC . In a small study, Ali et al reported comparable short‐ and long‐term outcomes for patients who had undergone hepatic ± vascular resection .…”

“…In a separate study, Yoh et al reported that patients with vascular invasion who underwent resection had an improved long‐term survival compared with patients who did not. These, and other previous studies have been limited, however, by small sample sizes arising from single institutional case series . As such, the objective of the current study was to define the perioperative and oncologic outcomes of patients with ICC undergoing curative‐intent hepatectomy with a concomitant major vascular resection using a large international multi‐institutional database.…”

Primary Hepatic Adenosquamous Carcinoma Associated with Primary Sclerosing Cholangitis

“…Primary hepatic adenosquamous carcinoma (ASC) is defined as a rare subtype of cholangiocarcinoma, accounting for 2-3% of cholangiocarcinomas [3][4][5] . ASC contains both adenocarcinoma (AC) and squamous cell carcinoma (SCC) components, tends to present more aggressive clinicopathologic features, and has a poorer prognosis than other cholangiocarcinomas [6,7] .…”