Long-term outcomes of anatomic vs. non-anatomic resection in intrahepatic cholangiocarcinoma with hepatolithiasis: A multicenter retrospective study

Abstract

BackgroundThe benefits of anatomic resection (AR) vs. non-anatomic resection (NAR) in patients with primary intrahepatic cholangiocarcinoma (ICC) with hepatolithiasis (HICC) are unclear. This study aimed to compare the long-term outcomes of AR vs. NAR in patients with HICC.MethodsA total of 147 consecutive patients with HICC who underwent R0 hepatectomy were included. Overall survival (OS) and recurrence-free survival (RFS) following AR vs. NARs were compared using a 1:1 propensity score matching (PSM) analysis. A subgroup analysis was also conducted according to whether there are lymph node metastases (LNM).ResultsIn a multivariate analysis, CA 19-9 (>39 U/L), microvascular invasion, LNM, and NAR were independent risk factors for poor RFS and OS rates, whereas multiple tumors were independent risk factors for OS. AR had better 1-, 3-, and 5-year RFS and OS rates than NAR (OS: 78.7, 58.9, and 28.5%, respectively, vs. 61.2, 25.4, and 8.8%, respectively; RFS: 59.5, 36.5, and 20.5%, respectively, vs. 38.2, 12.1, and 6.9%, respectively). After PSM, 100 patients were enrolled. The NAR group also had significantly poorer OS and RFS (OS: 0.016; RFS: p = 0.010) than the AR group. The subgroup analysis demonstrated that in HICC without LNM, OS and RFS were significantly poorer in the NAR group than the AR group, while no significant differences were observed in HICC with LNM before or after PSM.ConclusionAnatomic resection was associated with better long-term survival outcomes than NAR in patients with HICC, except for patients with LNM.

Anatomic versus non-anatomic resection for early-stage intrahepatic cholangiocarcinoma: a propensity score matching and stabilized inverse probability of treatment weighting analysis

“…A comprehensive literature search was conducted in databases including PubMed, Embase, the Cochrane Library, Medline, and Web of Science to identify relevant studies evaluating the potential benefits of AR for ICC patients. Ultimately, as presented in Supplementary Table 3 , a total of six studies encompassing 1523 patients were included in the analysis [ 13 , 14 , 19 , 31 – 33 ], with 764 patients allocated to the AR group and 759 patients allocated to the NAR group. The findings from five studies collectively indicated a favorable effect of AR on the prognosis of ICC, along with reduced rates of postoperative recurrence [ 13 , 14 , 31 – 33 ].…”

“…Ultimately, as presented in Supplementary Table 3 , a total of six studies encompassing 1523 patients were included in the analysis [ 13 , 14 , 19 , 31 – 33 ], with 764 patients allocated to the AR group and 759 patients allocated to the NAR group. The findings from five studies collectively indicated a favorable effect of AR on the prognosis of ICC, along with reduced rates of postoperative recurrence [ 13 , 14 , 31 – 33 ]. Conversely, the outcomes of the remaining study indicated that the implementation of AR did not yield improvements in prognosis among patients with solitary ICC that lacked direct invasion of adjacent organs or extrahepatic metastases [ 19 ].…”

“…In a Japanese nationwide survey of 5781 hepatocellular carcinoma (HCC) patients, Eguchi et al [ 9 ] firstly identified the advantage of AR in DFS, especially among those with tumor diameter of 2–5 cm, which was confirmed in numerous subsequent studies [ 10 – 12 ]. Furthermore, despite the limited and sparse literature available on this topic, reports have indicated a survival advantage of AR in patients with ICC [ 13 , 14 ].…”

“…One size does not fit for all. Given the evident inconsistencies in comparing AR and NAR for ICC [ 13 , 14 , 19 ], it is reasonable to assume the existence of a subgroup that does not benefit from AR. For instance, in cases where small HCC may not derive substantial benefits from AR, we hypothesized that the surgical approach would not significantly impact the long-term prognosis of early-stage ICC [ 6 , 20 , 21 ].…”