Outcome after liver resection for primary and recurrent intrahepatic cholangiocarcinoma

Abstract

BackgroundLiver resection is the only curative therapeutic option for intrahepatic cholangiocarcinoma (ICC), but the approach to recurrent ICC is controversial. This study analysed the outcome of liver resection in patients with recurrent ICC.MethodsDemographic, radiological, clinical, operative, surgical pathological and follow‐up data for all patients with a final surgical pathological diagnosis of ICC treated in a tertiary referral centre between 2001 and 2015 were collected retrospectively and analysed.ResultsA total of 190 patients had liver resection for primary ICC. The 1‐, 3‐ and 5‐year overall survival (OS) rates were 74·8, 56·6 and 37·9 per cent respectively. Independent determinants of OS were age 65 years or above (hazard ratio (HR) 2·18, 95 per cent c.i. 1·18 to 4·0; P = 0·012), median tumour diameter 5 cm or greater (HR 2·87, 1·37 to 6·00; P = 0·005), preoperative biliary drainage (HR 2·65, 1·13 to 6·20; P = 0·025) and local R1–2 status (HR 1·90, 1·02 to 3·53; P = 0·043). Recurrence was documented in 87 patients (45·8 per cent). The mean(s.d.) survival time after recurrence was 16(17) months. Independent determinants of recurrence were median tumour diameter 5 cm or more (HR 1·71, 1·09 to 2·68; P = 0·020), high‐grade (G3–4) tumour (HR 1·63, 1·04 to 2·55; P = 0·034) and local R1 status (HR 1·70, 1·09 to 2·65; P = 0·020). Repeat resection with curative intent was performed in 25 patients for recurrent ICC, achieving a mean survival of 25 (95 per cent c.i. 16 to 34) months after the diagnosis of recurrence. Patients deemed to have unresectable disease after recurrence received chemotherapy or chemoradiotherapy alone, and had significantly poorer survival.ConclusionPatients with recurrent ICC may benefit from repeat surgical resection.

The Presence of Small Nerve Fibers in the Tumor Microenvironment as Predictive Biomarker of Oncological Outcome Following Partial Hepatectomy for Intrahepatic Cholangiocarcinoma

“…This well-illustrates that tumor recurrence remains the major problem in iCCA patients. Repeated liver resections which provide appropriate long-term outcome are unfortunately only applicable for the minority of patients experiencing tumor recurrence [46,47]. Most patients still undergo systemic therapy, which is characterized by limited response and resistance to chemotherapy, thus resulting in early disease progression [6].…”

Renal metastasis from intrahepatic cholangiocarcinoma

“…Consequently, this search yielded only one case report on renal metastasis from ICC, where histological examination revealed squamous cell carcinoma [13]. In addition, we found nine studies regarding surgical treatment for recurrent ICC and reviewed in Table 1 [14][15][16][17][18][19][20][21][22]. Among them, there are two case series including a case of renal metastasis which was treated with surgical resection.…”

Systematic Review and Meta-Analysis of Prognostic Factors for Early Recurrence in Intrahepatic Cholangiocarcinoma After Curative-Intent Resection

“…Four studies met our primary objective of reporting ER, [8][9][10]29 and six studies met our secondary objective of reporting 24-month DFS. [30][31][32][33][34][35]…”

“…These studies involved 4158 patients. [8][9][10][29][30][31][32][33][34][35] Nine of the studies were retrospective cohort studies, and the remaining study was a prospective cohort study. The publication years of the studies ranged from 2010 to 2020.…”