Influence of hepatic resection margin on recurrence and survival in intrahepatic cholangiocarcinoma.

Department of Surgery, Hepatobiliary Service, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
Annals of Surgical Oncology (Impact Factor: 3.94). 09/2008; 15(10):2787-94. DOI: 10.1245/s10434-008-0081-1
Source: PubMed

ABSTRACT Intrahepatic cholangiocarcinoma (ICC) is a rare disease in the Western world, hence little is known about its optimal surgical management. We analyzed whether hepatic resection margin is a prognostic factor for local or distant recurrence and survival in patients resected with curative intent.
Seventy-four patients underwent potentially curative surgery for ICC at our institution from 1994 to 2007. Demographic, and tumor- and surgery-related details including hepatic resection margin were recorded, patients were followed up for recurrence and survival. All patients were resected using modern dissection devices (CUSA or Waterjet).
Fifty-nine patients (80%) underwent R0 resection, 15 (20%) had a resection margin greater than 10 mm (wide margin, WM) and 38 (51%) between 1 and 10 mm (close margin, CM). In 14 patients (19%), hepatic resection margin was involved on histological examination; perioperative mortalities were excluded from analysis (n = 7). Forty-seven patients developed recurrence (WM, CM, and R1): hepatic recurrence was observed in 40%, 58%, and 50% of patients; extrahepatic spread occurred in 27, 16, and 14%; and 33, 26, and 36% had no recurrence of disease so far (P = 0.755). There was no difference between groups regarding local versus disseminated hepatic recurrence. Median recurrence free survival was 11.4 months (WM), 9.8 months (CM), and 9.9 months (R1), respectively (P = 0.880). Median overall survival was 27.2 months (WM), 29.7 months (CM), and not reached in the R1 group, (P = 0.350).
Hepatic resection margin seems to play a minor role in the prognosis of ICC as long as complete tumor clearance can be achieved with a modern liver dissection technique.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to determine the therapeutic efficacy and safety of transarterial chemoembolization (TACE) with gemcitabine and oxaliplatin in patients with advanced biliary tract cancer (BTC). We retrospectively analyzed the outcomes for 65 patients with advanced BTC treated by TACE with gemcitabine 1,000 mg/m(2) and oxaliplatin 100 mg/m(2). Follow-up laboratory tests and computed tomography or magnetic resonance imaging were performed routinely to evaluate the response of the tumor to treatment. All patients were assessed for adverse effects. Of the 65 patients, 19 (29.2%) achieved a partial response, 36 (55.4%) showed stable disease, and ten (15.4%) showed progressive disease. The overall response rate was 29.2%. At the end of this study, five patients were still alive. The median overall survival was 12.0 months (95% confidence interval 8.5-15.5). There were no serious complications after TACE. The disease control rate and overall survival in this retrospective study were consistent with those in previous reports. TACE with gemcitabine and oxaliplatin was well tolerated and highly effective in patients with advanced BTC.
    OncoTargets and Therapy 01/2015; 8:595-600. DOI:10.2147/OTT.S79316 · 1.34 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Lymph node (LN) metastasis from intrahepatic cholangiocarcinoma (IHCC) might be one of the most important indicators of aggressive surgical resection, yet the value of LN dissection is still controversial. To address this clinical problem, we need to better understand the multidirectional lymphatic outflow from the liver. Although most hepatic lymph flows into the hilar LNs along portal triads, there are also several lymphatic outflows directly communicating with distant areas or the general lymphatic system. Moreover, it has been revealed that LN metastasis spreads to more distal LNs through the hepatoduodenal ligament or other multidirectional lymphatic pathways connected to the general lymphatic system. Therefore, systematic LN dissection might merely be LN sampling in IHCC with LN metastasis. A multidisciplinary strategy focusing on adjuvant treatment after surgery is immediately necessary in these cases. In IHCC without LN metastasis, the accuracy of preoperative imaging assessment of LN metastasis is unsatisfactory and useless for detecting metastatic LNs in clinical settings. Therefore, prophylactic systematic LN dissection for IHCC without preoperative LN swelling is recommended for accurate LN status assessment and reduction of local recurrences. However, this procedure might not offer any clinical benefit according to the results of retrospective comparative studies. In this review, we summarize previous reports regarding lymphatic outflow of the liver and discuss LN dissection for IHCC.
    Journal of Gastroenterology 04/2015; DOI:10.1007/s00535-015-1071-2 · 4.02 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Although use of lymphadenectomy for treatment of extrahepatic cholangiocarcinoma is established, routine lymphadenectomy for intrahepatic cholangiocarcinoma (ICC) remains controversial. We examined the factors predicting survival in patients after ICC resection and compared outcomes of patients with and without systematic hepatic pedicle lymph node dissection (LND). Data were retrospectively collected for 215 patients with ICC who underwent liver resection during the years 1995-2012. Patients were divided into those (n = 102; 47.4%) who received LND (LN [D]) and those (n = 113; 52.6%) who did not (LN [D0]). Demographic data were similar between the 2 groups except for presence of preoperative symptom (P = .019) and liver cirrhosis (P < .001), carbohydrate antigen 19-9 (P = .003), tumor location according to the hepatic lobe (P < .001), type of hepatectomy (P < .001), adjuvant treatment (P < .001), and postoperative complications (P = .028). Tumor recurrence at a distant site was observed in 102 patients (68.5%). LN metastasis was independently associated with risk of distant recurrence (P = .002). The LN (D) and LN (D0) groups did not differ in overall survival (P = .101) or disease-free survival (P = .111). Poorly differentiated histologic grade (P = .016) and LN metastasis (P < .001) was identified as an independent predictor of overall survival. Routine LND for ICC did not show survival benefits; however, LN sampling might be useful for nodal staging, an essential factor in predicting outcome and deciding whether to apply adjuvant treatment. Copyright © 2015 Elsevier Inc. All rights reserved.
    Surgery 02/2015; 157(4). DOI:10.1016/j.surg.2014.11.006 · 3.11 Impact Factor