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Multicenter Study
. 2015 Jul;22(7):2218-25.
doi: 10.1245/s10434-014-4223-3. Epub 2014 Oct 30.

Is Hepatic Resection for Large or Multifocal Intrahepatic Cholangiocarcinoma Justified? Results from a Multi-Institutional Collaboration

Gaya Spolverato  1 , Yuhree Kim, Sorin Alexandrescu, Irinel Popescu, Hugo P Marques, Luca Aldrighetti, T Clark Gamblin, John Miura, Shishir K Maithel, Malcolm H Squires, Carlo Pulitano, Charbel Sandroussi, Gilles Mentha, Todd W Bauer, Timothy Newhook, Feng Shen, George A Poultsides, J Wallis Marsh, Timothy M Pawlik
Affiliations
Multicenter Study

Is Hepatic Resection for Large or Multifocal Intrahepatic Cholangiocarcinoma Justified? Results from a Multi-Institutional Collaboration

Gaya Spolverato et al. Ann Surg Oncol. 2015 Jul.

Abstract

Background: The role of surgical resection for patients with large or multifocal intrahepatic cholangiocarcinoma (ICC) remains unclear. This study evaluated the long-term outcome of patients who underwent hepatic resection for large (≥7 cm) or multifocal (≥2) ICC.

Methods: Between 1990 and 2013, 557 patients who underwent liver resection for ICC were identified from a multi-institutional database. Clinicopathologic characteristics, operative details, and long-term survival data were evaluated.

Results: Of the 557 patients, 215 (38.6 %) had a small, solitary ICC (group A) and 342 (61.4 %) had a large or multifocal ICC (group B). The patients in group B underwent an extended hepatectomy more frequently (16.9 vs. 30.4 %; P < 0.001). At the final pathology exam, the patients in group B were more likely to show evidence of vascular invasion (22.5 vs. 38.5 %), direct invasion of contiguous organs (6.5 vs. 12.9 %), and nodal metastasis (13.3 vs. 21.0 %) (all P < 0.05). Interestingly, the incidences of postoperative complications (39.3 vs. 46.8 %) and hospital mortality (1.1 vs. 3.7 %) were similar between the two groups (both P > 0.05). The group A patients had better rates for 5-year overall survival (OS) (30.5 vs. 18.7 %; P < 0.05) and disease-free survival (DFS) (22.6 vs. 8.2 %; P < 0.05) than the group B patients. For the patients in group B, the factors associated with a worse OS included more than three tumor nodules [hazard ratio (HR), 1.56], nodal metastasis (HR, 1.47), and poor differentiation (HR, 1.48).

Conclusions: Liver resection can be performed safely for patients with large or multifocal ICC. The long-term outcome for these patients can be stratified on the basis of a prognostic score that includes tumor number, nodal metastasis, and poor differentiation.

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Conflict of interest statement

CONFLICT OF INTEREST There are no conflicts of interest.

Figures

FIG. 1
FIG. 1
a Disease-free survival (DFS) curves of patients undergoing hepatic resection for intrahepatic cholangiocarcinoma (ICC): group A (small solitary ICC) and group B (large or multifocal ICC). b Overall survival (OS) curves of patients undergoing hepatic resection for ICC: group A (small solitary ICC) and group B (large or multifocal ICC)
FIG. 2
FIG. 2
Overall survival curves of group B patients stratified by the number of risk factors present.
See this image and copyright information in PMC

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