Skip to main content
SpringerLink
Log in

Factors affecting survival after resection of intrahepatic cholangiocarcinoma

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

This study aimed at assessing the prognostic factors of resection of intrahepatic cholangiocarcinoma (IHCC), which remain unclear.

Methods

Among 70 patients with IHCC, who were admitted to our hospital between 1998 and 2011, 45 (64 %) underwent resection and 25 had unresectable tumors. Univariate and multivariate analyses were conducted retrospectively to assess the factors influencing survival of the patients who underwent resection.

Results

The median survival times of the patients who underwent resection versus those who did not were 16 months versus 9 months, respectively (P < 0.001). Multivariate analysis identified residual tumor status (relative risk 4.12, P = 0.04) and pathological differentiation (relative risk 5.55, P = 0.04) as independent factors predicting survival. Patients who underwent R1 resection had a significantly higher rate of local recurrence than those who underwent R0 resection (P = 0.008). With R0 resection, there were no significant differences in patterns and rates of recurrence between patients with narrow (≤5 mm) versus wide (>5 mm) surgical margins.

Conclusions

R0/1 resection and a well-differentiated tumor were found to be independent prognostic factors for long-term survival after IHCC resection. If R0 resection was achieved, the width of the negative surgical margin did not affect the patterns and rates of recurrence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ikai I, Arii S, Okazaki M, Okita K, Omata M, Kojiro M, et al. Report of the 17th nationwide follow-up survey of primary liver cancer in Japan. Hepatol Res. 2007;37:676–91.

    Article  PubMed  Google Scholar 

  2. Yamamoto M, Ariizumi S. Surgical outcomes of intrahepatic cholangiocarcinoma. Surg Today. 2011;41:896–902.

    Article  PubMed  Google Scholar 

  3. Yamashita Y, Taketomi A, Morita K, Fukuhara T, Ueda S, Sanefuji K, et al. The impact of surgical treatment and poor prognostic factors for patients with intrahepatic cholangiocarcinoma: retrospective analysis of 60 patients. Anticancer Res. 2008;28:2353–9.

    PubMed  Google Scholar 

  4. Uenishi T, Kubo S, Yamazaki O, Yamada T, Sasaki Y, Nagano H, et al. Indications for surgical treatment of intrahepatic cholangiocarcinoma with lymph node metastases. J Hepatobiliary Pancreat Surg. 2008;15:417–22.

    Article  PubMed  Google Scholar 

  5. de Jong MC, Nathan H, Sotiropoulos GC, Paul A, Alexandrescu S, Marques H, et al. Intrahepatic cholangiocarcinoma: an international multi-institutional analysis of prognostic factors and lymph node assessment. J Clin Oncol. 2011;29:3140–5.

    Article  PubMed  Google Scholar 

  6. Murakami Y, Uemura K, Sudo T, Hashimoto Y, Nakashima A, Sueda T. Intrahepatic cholangiocarcinoma: clinicopathological differences between peripheral type and hilar type. J Gastrointest Surg. 2012;16:540–8.

    Article  PubMed  Google Scholar 

  7. Nakagohri T, Kinoshita T, Konishi M, Takahashi S, Gotohda N. Surgical outcome and prognostic factors in intrahepatic cholangiocarcinoma. World J Surg. 2008;32:2675–80.

    Article  PubMed  Google Scholar 

  8. Morimoto Y, Tanaka Y, Ito T, Nakahara M, Nakaba H, Nishida T, et al. Long-term survival and prognostic factors in the surgical treatment for intrahepatic cholangiocarcinoma. J Hepatobiliary Pancreat Surg. 2003;10:432–40.

    Article  PubMed  Google Scholar 

  9. Ohtsuka M, Ito H, Kimura F, Shimizu H, Togawa A, Yoshidome H, et al. Results of surgical treatment for intrahepatic cholangiocarcinoma and clinicopathological factors influencing survival. Br J Surg. 2002;89:1525–31.

    Article  PubMed  CAS  Google Scholar 

  10. Tamandl D, Herberger B, Gruenberger B, Puhalla H, Klinger M, Gruenberger T. Influence of hepatic resection margin on recurrence and survival in intrahepatic cholangiocarcinoma. Ann Surg Oncol. 2008;15:2787–94.

    Article  PubMed  Google Scholar 

  11. Guglielmi A, Ruzzenente A, Campagnaro T, Pachera S, Valdegamberi A, Nicoli P, et al. Intrahepatic cholangiocarcinoma: prognostic factors after surgical resection. World J Surg. 2009;33:1247–54.

    Article  PubMed  Google Scholar 

  12. Sobin LH, Gospodrowicz MK, Wittekind CH. TNM classification of malignant tumours. 7th ed. New York: Wiley-Blackwell; 2009. pp. 114–117.

  13. Trotti A, Byhardt R, Stetz J, Gwede C, Corn B, Fu K, et al. Common toxicity criteria: version 2.0. An improved reference for grading the acute effects of cancer treatment: impact on radiotherapy. Int J Radiat Oncol Biol Phys. 2000;47:13–47.

    Article  PubMed  CAS  Google Scholar 

  14. Cho SY, Park SJ, Kim SH, Han SS, Kim YK, Lee KW, et al. Survival analysis of intrahepatic cholangiocarcinoma after resection. Ann Surg Oncol. 2010;17:1823–30.

    Article  PubMed  Google Scholar 

  15. Morine Y, Shimada M, Utsunomiya T, Imura S, Ikemoto T, Mori H, et al. Clinical impact of lymph node dissection in surgery for peripheral-type intrahepatic cholangiocarcinoma. Surg Today. 2012;42:147–51.

    Article  PubMed  Google Scholar 

  16. Farges O, Fuks D, Boleslawski E, Le Treut YP, Castaing D, Laurent A, et al. Influence of surgical margins on outcome in patients with intrahepatic cholangiocarcinoma: a multicenter study by the AFC-IHCC-2009 study group. Ann Surg. 2011;254:824–9 (discussion 830).

    Article  PubMed  Google Scholar 

  17. Weber SM, Jarnagin WR, Klimstra D, DeMatteo RP, Fong Y, Blumgart LH. Intrahepatic cholangiocarcinoma: resectability, recurrence pattern, and outcomes. J Am Coll Surg. 2001;193:384–91.

    Article  PubMed  CAS  Google Scholar 

  18. Lang H, Sotiropoulos GC, Sgourakis G, Schmitz KJ, Paul A, Hilgard P, et al. Operations for intrahepatic cholangiocarcinoma: single-institution experience of 158 patients. J Am Coll Surg. 2009;208:218–28.

    Article  PubMed  Google Scholar 

  19. Saxena A, Chua TC, Sarkar A, Chu F, Morris DL. Clinicopathologic and treatment-related factors influencing recurrence and survival after hepatic resection of intrahepatic cholangiocarcinoma: a 19-year experience from an established Australian hepatobiliary unit. J Gastrointest Surg. 2010;14:1128–38.

    Article  PubMed  Google Scholar 

  20. Bodingbauer M, Tamandl D, Schmid K, Plank C, Schima W, Gruenberger T. Size of surgical margin does not influence recurrence rates after curative liver resection for colorectal cancer liver metastases. Br J Surg. 2007;94:1133–8.

    Article  PubMed  CAS  Google Scholar 

  21. Yedibela S, Demir R, Zhang W, Meyer T, Hohenberger W, Schonleben F. Surgical treatment of mass-forming intrahepatic cholangiocarcinoma: an 11-year Western single-center experience in 107 patients. Ann Surg Oncol. 2009;16:404–12.

    Article  PubMed  Google Scholar 

  22. Nakagawa T, Kamiyama T, Kurauchi N, Matsushita M, Nakanishi K, Kamachi H, et al. Number of lymph node metastases is a significant prognostic factor in intrahepatic cholangiocarcinoma. World J Surg. 2005;29:728–33.

    Article  PubMed  Google Scholar 

  23. Li SQ, Liang LJ, Hua YP, Peng BG, He Q, Lu MD, et al. Long-term outcome and prognostic factors of intrahepatic cholangiocarcinoma. Chin Med J (Engl). 2009;122:2286–91.

    Google Scholar 

  24. Uchiyama K, Yamamoto M, Yamaue H, Ariizumi S, Aoki T, Kokudo N, et al. Impact of nodal involvement on surgical outcomes of intrahepatic cholangiocarcinoma: a multicenter analysis by the Study Group for Hepatic Surgery of the Japanese Society of Hepato-Biliary-Pancreatic Surgery. J Hepatobiliary Pancreat Sci. 2011;18:443–52.

    Article  PubMed  Google Scholar 

  25. Shimada K, Sano T, Sakamoto Y, Esaki M, Kosuge T, Ojima H. Clinical impact of the surgical margin status in hepatectomy for solitary mass-forming type intrahepatic cholangiocarcinoma without lymph node metastases. J Surg Oncol. 2007;96:160–5.

    Article  PubMed  Google Scholar 

  26. Valverde A, Bonhomme N, Farges O, Sauvanet A, Flejou JF, Belghiti J. Resection of intrahepatic cholangiocarcinoma: a Western experience. J Hepatobiliary Pancreat Surg. 1999;6:122–7.

    Article  PubMed  CAS  Google Scholar 

  27. Cherqui D, Tantawi B, Alon R, Piedbois P, Rahmouni A, Dhumeaux D, et al. Intrahepatic cholangiocarcinoma. Results of aggressive surgical management. Arch Surg. 1995;130:1073–8.

    Article  PubMed  CAS  Google Scholar 

  28. Holdhoff M, Schmidt K, Diehl F, Aggrawal N, Angenendt P, Romans K, et al. Detection of tumor DNA at the margins of colorectal cancer liver metastasis. Clin Cancer Res. 2011;17:3551–7.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  29. Ribero D, Pinna AD, Guglielmi A, Ponti A, Nuzzo G, Giulini SM, et al. Surgical approach for long-term survival of patients with intrahepatic cholangiocarcinoma: a multi-institutional analysis of 434 patients. Arch Surg. 2012;147:1107–13.

    Google Scholar 

  30. Suzuki S, Sakaguchi T, Yokoi Y, Okamoto K, Kurachi K, Tsuchiya Y, et al. Clinicopathological prognostic factors and impact of surgical treatment of mass-forming intrahepatic cholangiocarcinoma. World J Surg. 2002;26:687–93.

    Article  PubMed  Google Scholar 

  31. Miwa S, Miyagawa S, Kobayashi A, Akahane Y, Nakata T, Mihara M, et al. Predictive factors for intrahepatic cholangiocarcinoma recurrence in the liver following surgery. J Gastroenterol. 2006;41:893–900.

    Article  PubMed  CAS  Google Scholar 

  32. Endo I, Gonen M, Yopp AC, Dalal KM, Zhou Q, Klimstra D, et al. Intrahepatic cholangiocarcinoma: rising frequency, improved survival, and determinants of outcome after resection. Ann Surg. 2008;248:84–96.

    Article  PubMed  Google Scholar 

  33. Shirabe K, Mano Y, Taketomi A, Soejima Y, Uchiyama H, Aishima S, et al. Clinicopathological prognostic factors after hepatectomy for patients with mass-forming type intrahepatic cholangiocarcinoma: relevance of the lymphatic invasion index. Ann Surg Oncol. 2010;17:1816–22.

    Article  PubMed  Google Scholar 

  34. Soyer P, Pelage JP, Dufresne AC, Boudiaf M, Kardache M, Dahan H, et al. CT of abdominal wall implantation metastases after abdominal percutaneous procedures. J Comput Assist Tomogr. 1998;22:889–93.

    Article  PubMed  CAS  Google Scholar 

  35. Shinohara ET, Mitra N, Guo M, Metz JM. Radiation therapy is associated with improved survival in the adjuvant and definitive treatment of intrahepatic cholangiocarcinoma. Int J Radiat Oncol Biol Phys. 2008;72:1495–501.

    Article  PubMed  Google Scholar 

  36. Murakami Y, Uemura K, Sudo T, Hashimoto Y, Nakashima A, Kondo N, et al. Prognostic factors after surgical resection for intrahepatic, hilar, and distal cholangiocarcinoma. Ann Surg Oncol. 2011;18:651–8.

    Article  PubMed  Google Scholar 

  37. Shen WF, Zhong W, Liu Q, Sui CJ, Huang YQ, Yang JM. Adjuvant transcatheter arterial chemoembolization for intrahepatic cholangiocarcinoma after curative surgery: retrospective control study. World J Surg. 2011;35:2083–91.

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

We have no conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan

    Sae Murakami, Tetsuo Ajiki, Taro Okazaki, Kimihiko Ueno, Masahiro Kido, Ippei Matsumoto, Takumi Fukumoto & Yonson Ku

Authors
  1. Sae Murakami
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tetsuo Ajiki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Taro Okazaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kimihiko Ueno
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Masahiro Kido
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ippei Matsumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Takumi Fukumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yonson Ku
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tetsuo Ajiki.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Murakami, S., Ajiki, T., Okazaki, T. et al. Factors affecting survival after resection of intrahepatic cholangiocarcinoma. Surg Today 44, 1847–1854 (2014). https://doi.org/10.1007/s00595-013-0825-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-013-0825-9

Keywords

Search

Navigation