Surgical Treatment of Intrahepatic Cholangiocarcinoma: Current and Emerging Principles

Abstract

Intrahepatic cholangiocarcinoma (ICC) is a rare, aggressive cancer of the biliary tract. It often presents with locally advanced or metastatic disease, but for patients with early-stage disease, surgical resection with negative margins and portahepatis lymphadenectomy is the standard of care. Recent advancements in ICC include refinement of staging, improvement in liver-directed therapies, clarification of the role of adjuvant therapy based on new randomized controlled trials, and advances in minimally invasive liver surgery. In addition, improvements in neoadjuvant strategies and surgical techniques have enabled expanded surgical indications and reduced surgical morbidity and mortality. However, recurrence rates remain high and more effective systemic therapies are still necessary to improve recurrence-free and overall survival. In this review, we focus on current and emerging surgical principals for the management of ICC including preoperative evaluation, current indications for surgery, strategies for future liver remnant augmentation, technical principles, and the role of neoadjuvant and adjuvant therapies.

Keywords: biliary tract cancers; intrahepatic cholangiocarcinoma; liver transplantation; surgery.

Figure 1

Infiltrative intrahepatic cholangiocarcinoma (ICC) (short, white arrow) with involvement of the right portal vein on magnetic resonance imaging (MRI; (A), coronal and (B), axial) and computed tomography (CT; (C), coronal and (D), axial). ICC, intrahepatic cholangiocarcinoma; MRI, magnetic resonance imaging; CT, computed tomography.

Figure 2

Gastrohepatic lymph node recurrence (short red arrow) in a patient who previously underwent left hepatectomy without porta hepatis lymphadenectomy for ICC.