Journal of Gastroenterology

, Volume 41, Issue 9, pp 893–900

Predictive factors for intrahepatic cholangiocarcinoma recurrence in the liver following surgery

Authors

  • Shiro Miwa
    • Department of SurgeryShinshu University School of Medicine
  • Shinichi Miyagawa
    • Department of SurgeryShinshu University School of Medicine
  • Akira Kobayashi
    • Department of SurgeryShinshu University School of Medicine
  • Yasuhiko Akahane
    • Department of SurgeryShinshu University School of Medicine
  • Takenari Nakata
    • Department of SurgeryShinshu University School of Medicine
  • Motohiro Mihara
    • Department of SurgeryShinshu University School of Medicine
  • Kei Kusama
    • Department of SurgeryShinshu University School of Medicine
  • Junpei Soeda
    • Department of SurgeryShinshu University School of Medicine
  • Shinichiro Ogawa
    • Department of SurgeryShinshu University School of Medicine
Article

DOI: 10.1007/s00535-006-1877-z

Cite this article as:
Miwa, S., Miyagawa, S., Kobayashi, A. et al. J Gastroenterol (2006) 41: 893. doi:10.1007/s00535-006-1877-z

Abstract

Background

We performed hepatectomy without lymph node (LN) dissection for intrahepatic cholangiocarcinoma (ICC) limited to the peripheral region of the liver, and hepatectomy with extrahepatic bile duct resection and regional LN dissection for any types of ICC extending to the hepatic hilum. Surgical outcomes were evaluated to elucidate the prognostic factors that influence patient survival with respect to intrahepatic recurrence.

Methods

Forty-one patients underwent resection of ICC with no macroscopic evidence of residual cancer.

Results

Significant risk factors for poorer survival included preoperative jaundice (P = 0.0115), serum CA19-9 levels >37 U/ml (P = 0.0089), tumor diameter >4.5 cm (P = 0.017), ICC extending to the hepatic hilum (P = 0.0065), mass-forming with periductal-infiltrating type (P = 0.003), poorly differentiated adenocarcinoma, portal vein involvement (P = 0.0785), LN metastasis at initial hepatectomy (P < 0.0001), and positive surgical margin (P = 0.023). Intrahepatic recurrence, which was the predominant manner of recurrence, was detected in 20 patients (74.1%). Patients with intrahepatic recurrence had a significantly high incidence of high serum CA19-9 levels (>37 U/ml; P = 0.0006), preoperative jaundice (P = 0.0262), ICC extended to the hepatic hilum (P = 0.0349), large tumors (>4.5 cm; P = 0.0351), portal vein involvement (P = 0.0423), and LN metastasis at initial hepatectomy (P = 0.009) compared with disease-free patients. The multiple logistic regression analysis revealed that preoperative CA19-9 elevation and obstructive jaundice influenced intrahepatic recurrence of ICC.

Conclusions

Although LN metastasis is a significant prognostic factor, the most obvious recurrence pattern after surgery was intrahepatic recurrence, which could be predicted preoperatively by a combination of elevated serum CA19-9 levels and manifestation of obstructive jaundice.

Key words

intrahepatic cholangiocarcinoma intrahepatic recurrence predictive factor prognosis lymph node metastasis

Copyright information

© Springer-Verlag Tokyo 2006