Liver resection and transplantation for intrahepatic cholangiocarcinoma

Abstract

The incidence of intrahepatic cholangiocarcinoma (iCCA) is increasing worldwide. Although several advances have been made in the past decades to better understand this complex malignancy and to develop new treatment strategies, the prognosis of iCCA remains dismal. Liver resection (LR) is the mainstay of treatment but only a minority of patients are amenable to surgery. In most cases, patients with iCCA will require a major hepatectomy for complete resection of the tumour. This may be contraindicated or increase the surgical burden in patients with chronic liver disease and small remnant liver volume. Lymphadenectomy with a minimal harvest of 6 lymph nodes is considered adequate, as microscopic nodal metastases have been shown in more than 40% of patients. Current 5-year overall survival following LR is in the range of 25%-40%. For locally advanced disease not amenable to upfront LR, neoadjuvant locoregional therapies may be used with the aim of converting these patients to resectability or even to transplantation in well-selected cases. Recent studies have shown that liver transplantation (LT) might be a treatment option for patients with unresectable very-early iCCA (i.e. < − 2 cm), with survival outcomes comparable to those of hepatocellular carcinoma. In patients with unresectable, advanced tumours, confined to the liver who achieve sustained response to neoadjuvant treatment, LT may be considered an option within prospective protocols. The role of adjuvant therapies in iCCA is still under debate. Herein, we review the recent advances in the surgical treatment of iCCA and examine its correlation with locoregional therapies, adjuvant and neo-adjuvant strategies.

Drug-eluting beads transarterial chemoembolization with CalliSpheres microspheres for treatment of unresectable intrahepatic cholangiocarcinoma

“…International Publisher devastating prognosis and high mortality rate [2]. Liver resection is the mainstay treatment of this disease [1]. Unfortunately, most patients with ICC are found to have locally advanced or metastatic disease at the time of diagnosis.…”

“…Intrahepatic cholangiocarcinoma (ICC) is a fatal primary liver cancer arising from the epithelial lining of the peripheral intrahepatic bile duct epithelium [1].…”

LncRNA MNX1-AS1 promotes progression of intrahepatic cholangiocarcinoma through the MNX1/Hippo axis

“…In the last few decades, the incidence of ICC has been rising in both Eastern and Western countries paralleled by an increase in ICC-related mortality 1 . ICC has high malignancy, and surgical resection is currently the only widely accepted curative treatment 2 . However, it is difficult to diagnose at an early stage, leading to a loss of opportunity for surgery.…”

Identification of Potentially Therapeutic Target Genes of Hepatocellular Carcinoma

“…HCC mortality rates have risen over the last few decades in most countries [3]. HCC can be managed by the following main treatments: liver transplantation or resection [4], transcatheter arterial chemoembolization (TACE) [5], radiofrequency ablation (RFA) [6], transarterial radioembolization (TARE) [7], and targeted systemic chemotherapy [8]. Surgical treatment is normally considered standard potentially curative treatment for early-stage HCC [9].…”