Nonanatomic resection is not inferior to anatomic resection for primary intrahepatic cholangiocarcinoma: A propensity score analysis

Abstract

Whether anatomic resection (AR) achieves better outcomes than nonanatomic resection (NAR) in patients with primary intrahepatic cholangiocarcinoma (ICC) is unclear. Data were retrieved for all consecutive patients who underwent liver resection for primary ICC from January 2007 to July 2017. The prognoses of the patients without direct invasion to contiguous organs or extrahepatic metastasis who underwent AR or NAR were compared. 85 patients underwent AR, and 65 patients underwent NAR. operation time were slightly decreased in the NAR group. The risk of Clavien-Dindo classification (CDC) IV in the AR group was significant higher than that in the NAR group. Cox regression analysis showed lymph node metastasis and adjuvant therapy were significant prognostic factors for overall survival (OS) and disease-free survival (DFS), respectively. After 1:1 propensity score matching (PSM), 29 pairs of patients were compared. The survival curves showed the NAR group had slightly improved DFS and OS than the AR group before and after matching. Thus, we conclude NAR was not inferior to AR in improving the survival outcomes for patients with primary solitary ICC lesions without direct invasion to contiguous organs or extrahepatic metastasis. Furthermore, patients may benefit from NAR.

Comprehensive radiomics nomogram for predicting survival of patients with combined hepatocellular carcinoma and cholangiocarcinoma

“…Moreover, Chantajitr et al [ 46 ] found that dilation of the intrahepatic bile duct was related to a poor prognosis in cHCC-CCA patients, and Lee et al [ 47 ] suggested that an increased Child-Pugh score (mean score: 5.8) was related to early death in cHCC-CCA patients. The role of anatomical hepatectomy in the prognosis of cHCC-CCA patients has rarely been evaluated, and some studies have reported that anatomical hepatectomy can prolong the survival time of HCC, but had no benefit in ICC patients[ 48 , 49 ]. These findings imply that the impact of anatomical hepatectomy on OS in cHCC-CCA is unclear and further large scale studies with a prospective design should be conducted to verify the results of this study.…”

“…Studies have suggested that anatomical hepatectomy can prolong survival in HCC but not ICC patients[ 48 , 49 ]; however, we are unaware of studies that have examined this issue in cHCC-CCA patients. The impact of anatomical hepatectomy on OS of cHCC-CCA patients after resection should be explored in large, prospective studies.…”

Treatment of Intrahepatic Cholangiocarcinoma—A Multidisciplinary Approach

“…For a retrospective cohort of 702 cases, a slight oncological benefit was shown for anatomical compared to parenchyma sparing resections (5-year-survival: 36% vs. 25.3%; disease free survival: 28% vs. 18%, p < 0.05) [ 55 ]. However, others were not able to confirm these findings [ 56 ]. In summary, a R0 resection should always be aimed at, while in large tumors this is not always possible.…”

Parenchyma-Sparing Liver Resection or Regenerative Liver Surgery: Which Way to Go?

“…Anatomic and non-anatomic LRs are associated with comparable intraoperative bleeding and morbidity, but liver failure occurs more often following anatomic LR [ 111 ]. Non-anatomic LR has been linked with a higher rate of positive surgical margins, but this seemed to not impact the OS or the DFS [ 111 ]. However, it has also been shown that negative surgical margins are associated with a beneficial OS and PFS following resection for ICC [ 112 ].…”

“…Non-anatomic LR has proved to be non-inferior to anatomic LR in terms of survival in the case of solitary ICC not invading contiguous organs or extrahepatic metastases, which shows that these patients, particularly in the context of cirrhosis, could benefit more from a non-anatomic hepatectomy, given the lower risk of liver failure [ 111 ].…”