Digestive Diseases and Sciences

, Volume 59, Issue 1, pp 201–213

Prediction of the Postoperative Prognosis of Intrahepatic Cholangiocarcinoma (ICC): Importance of Preoperatively-Determined Anatomic Invasion Level and Number of Tumors

  • Shigeru Marubashi
  • Kunihito Gotoh
  • Hidenori Takahashi
  • Hiroaki Ohigashi
  • Masahiko Yano
  • Osamu Ishikawa
  • Masato Sakon
Original Article

DOI: 10.1007/s10620-013-2894-4

Cite this article as:
Marubashi, S., Gotoh, K., Takahashi, H. et al. Dig Dis Sci (2014) 59: 201. doi:10.1007/s10620-013-2894-4

Abstract

Background

Preoperative prediction of the prognosis of patients with intrahepatic cholangiocarcinoma (ICC) following surgical treatment remains quite difficult and controversial. We attempted to identify the preoperative and postoperative predictors of the overall survival rates in patients with ICC in order to clarify the appropriate indications for surgical resection of ICC.

Patients and Methods

We retrospectively investigated the clinicopathological features of ICC and outcome of surgical resection in 111 consecutive patients who underwent surgical treatment at our hospital between 1980 and March 2012. Both preoperative factors and operatively confirmed factors were evaluated as potential risk factors for determination of the post-surgical prognosis.

Results

Curative resection (R0) was performed in 72 patients (64.9 %). The 1- and 3-year overall survival rates were 85.0 and 59.7 % in the R0 group. Two preoperative factors [hilar invasion as recognized by computed tomography (HR 3.16, P = 0.020) and multiple intrahepatic tumors (HR 7.09, P = 0.0002)] and two operatively confirmed factors [multiple intrahepatic tumors (HR 9.17, P = 0.0009) and lymph node metastasis as confirmed by final histology (HR 6.41, P = 0.003)] were identified as significant risk factors adversely influencing the overall survival rate after surgery. Furthermore, solitary, small (<5 cm) and peripheral ICCs were associated with a very low probability of lymph node metastasis.

Conclusions

Preoperatively diagnosed hilar invasion, multiple intrahepatic tumors and histologically confirmed lymph node metastasis were the main determinants of an adverse postoperative prognosis in patients with ICC. Lymph node dissection could be omitted for patients with solitary, small and peripheral ICCs.

Keywords

Risk factorPreoperative diagnosisPostoperative prognosisLymph node dissectionRecurrence

Abbreviations

AST

Asparate aminotransferase

ALT

Alanine aminotransferase

CA19-9

Carbohydrate antigen 19-9

CBD

Common bile duct

CEA

Carcinoembryonic antigen

CT

Computed tomography

GGT

Gamma-glutamyltransferase

ICC

Intrahepatic cholangiocarcinoma

PET–CT

Positron emission tomography–computed tomography

PT

Prothrombin time

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Shigeru Marubashi
    • 1
  • Kunihito Gotoh
    • 1
  • Hidenori Takahashi
    • 1
  • Hiroaki Ohigashi
    • 1
  • Masahiko Yano
    • 1
  • Osamu Ishikawa
    • 1
  • Masato Sakon
    • 1
  1. 1.Department of SurgeryOsaka Medical Center for Cancer and Cardiovascular DiseasesOsakaJapan