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Intrahepatic cholangiocarcinoma: prognostic factors after liver resection

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Abstract

Liver resection may represent the only hope of cure for patients with intrahepatic cholangiocarcinoma (IHC) but long-term results are still far from satisfactory and the impact of prognostic factors is still controversial. Fifty-five patients underwent hepatectomy for IHC between 1997 and 2008 in our unit. Features of the patients and the tumors, operations, postoperative and long-term results were retrospectively assessed. Twenty-one patients had HBV/HCV infection, four had congenital biliary dilatation. Thirty-two patients had increased CA 19-9; 12 had multiple (≥4) tumors. Operations included 43 major resections, with 9 resections of biliary confluence, 40 regional lymphadenectomies. Operative mortality and morbidity were 0 and 27.3%, respectively. There were 44 R0-resections (80.0%). Lymphadenectomy yielded lymph node metastases in 14 cases (14/40; 35.0%). Five-year overall and disease-free survival rates were 30.2 and 27.5%, respectively. At multivariate analysis the strongest poor prognostic factor for overall survival was tumor stage. This factor, with multiplicity of lesions (≥4) and tumor grading > 2, was significant predictor of recurrence. CA19-9 > 100 IU/mL and tumor grading > 2 were found to be significantly related with early multinodular hepatic recurrence. Patients with lymph node metastases had significantly lower overall and disease-free survival but patients who underwent lymph node dissection with negative lymph nodes at final pathology showed significantly higher 5-year disease-free survival than patients who did not underwent lymphadenectomy. In conclusion, these results support the role of hepatectomy with regional lymphadenectomy as the best available treatment for IHC. Prognosis after liver resection correlates with clinical stage and multiplicity of lesions.

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Acknowledgments

We are sincerely grateful to Professor Masatoshi Makuuchi for his very helpful and constructive advice in the preparation of this manuscript. This study was supported by a contribution from the Catholic University and the Italian Ministry for University and Scientific Research (D.1 Funds).

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Authors and Affiliations

  1. Hepatobiliary Surgery Unit, Department of Surgical Sciences, Catholic University of the Sacred Heart School of Medicine, Largo A. Gemelli 8, 00168, Rome, Italy

    Gennaro Nuzzo, Felice Giuliante, Francesco Ardito, Agostino Maria De Rose, Maria Vellone, Gennaro Clemente, Carlo Chiarla & Ivo Giovannini

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  1. Gennaro Nuzzo
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  2. Felice Giuliante
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  3. Francesco Ardito
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  4. Agostino Maria De Rose
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  5. Maria Vellone
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  6. Gennaro Clemente
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  7. Carlo Chiarla
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  8. Ivo Giovannini
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Correspondence to Gennaro Nuzzo.

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Nuzzo, G., Giuliante, F., Ardito, F. et al. Intrahepatic cholangiocarcinoma: prognostic factors after liver resection. Updates Surg 62, 11–19 (2010). https://doi.org/10.1007/s13304-010-0007-x

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