Fifteen-year, single-center experience with the surgical management of intrahepatic cholangiocarcinoma: Operative results and long-term outcome

Recanati-Miller Transplantation Institute, Mount Sinai Medical Center, New York, NY, USA.
Surgery (Impact Factor: 3.11). 03/2008; 143(3):366-74. DOI: 10.1016/j.surg.2007.10.010
Source: PubMed

ABSTRACT Limited data exist regarding the role of extended liver resection for the management of intrahepatic cholangiocarcinoma (ICC), most of which derive from small single-center or larger multicenter series. In the current report, we present our experience with the surgical management of ICC, analyze operative results, and investigate prognostic factors in resected patients.
A total of 72 patients underwent operative exploration for ICC between 1991 and 2005; 54 patients were resected, and 18 patients were deemed unresectable based on intraoperative findings. Demographics, pathology, anatomic characteristics, operative results, and survival were analyzed.
The resectability rate was 71%, with negative margins achieved in 78% of the resected patients. Extended liver resections were performed in 24 (44%) of the 72 patients. Perioperative mortality after resection was 7%, with 11% morbidity. The 1-, 3- and 5-year survival rates after resection were 80%, 49% and 25%, respectively, and were significantly greater than for patients with unresectable disease (P < .001). R1 liver resections conferred increased 5-year survival compared with patients deemed unresectable (P = .03). None of the factors evaluated proved to be independent prognostic factors on multivariate analysis.
R0 resection of ICC provides the best chance for prolonged survival, whereas R1 resection appears to be superior to nonoperative treatment. Declining operative mortality as a result of improved intraoperative and perioperative care justifies the performance of extended liver resections in these patients, although benefit has to be evaluated with respect to nodal involvement.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Percutaneous radiofrequency ablation (RFA) has shown efficacy in patients with recurrent hepatocellular carcinoma, but has not been well documented in patients with recurrent intrahepatic cholangiocarcinoma (ICC). We therefore evaluated the long-term survival and safety of percutaneous RFA for patients with recurrent ICC after curative resection. A total of 20 patients with 29 recurrent ICCs underwent ultrasound-guided percutaneous RFA. All patients had undergone curative resection of the primary ICC. Tumor size ranged from 0.7 cm to 4.4 cm in maximum dimension (mean, 1.9 cm; median, 1.5 cm). The technical effectiveness rate of RFA was 97% (28/29) of recurrent ICCs. Mean local tumor progression-free survival was 39.8 months, and the cumulative local tumor progression-free 6 month and 1, 2, and 4 year survival rates were 93%, 74%, 74%, and 74%, respectively. Median overall survival after RFA was 27.4 months and the cumulative overall 6 month and 1, 2, and 4 year survival rates were 95%, 70%, 60%, and 21%, respectively. There were two major complications (one liver abscess and one biliary stricture, 7% per treatment) during the follow-up, but no procedure-related deaths. RFA is safe and provides successful local tumor control in patients with recurrent ICC after curative resection. RFA for recurrent ICC resulted in a median overall survival rate of 27.4 months after RFA in the present series.
    European journal of radiology 10/2010; 80(3):e221-5. DOI:10.1016/j.ejrad.2010.09.019 · 2.16 Impact Factor
  • [Show abstract] [Hide abstract]
    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.
    Annals of Surgical Oncology 09/2008; 15(10):2787-94. DOI:10.1245/s10434-008-0081-1 · 3.94 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: SocieteInternationale de Chirurgie 2008 Intrahepatic cholangiocarcinoma (ICC) accounts for 10- 20% of primary liver malignancies, with an increasing incidence in western countries during recent years. In general, prognosis is poor, with a reported median survival of less than 9 months after diagnosis in the majority of patients with unresectable disease (1). Aggressive resection is the mainstay of surgical treatment for ICC, offering patients the best chance for prolonged survival (2, 3). However, comparison of survival data in the literature is difficult due to the often inhomogeneous selection criteria and the small number of cases. In patients with resectable ICC, achieving a negative margin is considered the most important variable associ- ated with outcome and long-term survival (2). In this issue of the World Journal of Surgery, Nakagohri et al. (4) report 56 patients who underwent surgical resection for ICC during a 15-year period in a single institution. R0 resection was achieved in 75% of patients with a 5-year survival of 39%. Interestingly, long-term survival was possible even in patients with R1 resection, and 2 of 14 patients with positive margins survived more than 5 years. Similar results have recently been reported by others (3) and sug- gest that some patients may benefit from liver resection despite having pathologically involved resection margins. In recent years, in addition to resection margin status, numerous other prognostic factors have been investigated. In several studies, the negative prognostic influence of tumor-positive lymph nodes, microvascular or macrovas- cular infiltration, and multifocal tumor growth have been demonstrated (2, 3). Based on multivariate analysis, Nak- agohri et al. report that the presence of intrahepatic metastases was the only significant independent risk factor other than surgical resection status for ICC. In fact, no patient with intrahepatic metastases survived more than 10 months. This poor prognosis after resection of ICC with intrahepatic metastases could be considered a contraindi- cation for operative intervention, and underlines the need for improved selection of patients eligible for hepatic
    World Journal of Surgery 11/2008; 32(12):2681-2. DOI:10.1007/s00268-008-9730-6 · 2.35 Impact Factor