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Surgical interpretation of the WHO subclassification of intrahepatic cholangiocarcinoma: a narrative review

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Abstract

Intrahepatic cholangiocarcinoma (iCCA) has been subclassified by its gross morphology into the mass-forming (MF), periductal-infiltrating (PI), and intraductal growth (IG) types and their combinations. This classification correlates well with clinical features; for example, MF-iCCA has less lymph-node metastasis and a better prognosis than PI-iCCA. According to the recently accumulated evidence from histological investigations, the WHO classification endorsed a subclassification scheme in which iCCA cases are classified into small- and large-duct types. Small-duct iCCA is considered to originate from septal or smaller bile ducts and is characterized by less frequent lymph-node metastasis, a favorable prognosis, and an MF appearance. Large-duct iCCA arises around the second branch of the biliary tree and has more aggressive biology and distinct genetic abnormalities. According to the practice guidelines for iCCA from the Liver Cancer Study Group of Japan and the National Comprehensive Cancer Network, upfront surgery is recommended for iCCA without distant metastasis regardless of the morphological subtype, based on clinical experience. In consideration of the biological heterogeneity of iCCA, the treatment strategy for iCCA needs to be reconsidered based on the WHO subtypes.

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  1. Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan

    Masayuki Akita, Hiroaki Yanagimoto, Daisuke Tsugawa & Takumi Fukumoto

  2. Institute of Liver Studies, King’s College Hospital, London, UK

    Yoh Zen

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  1. Masayuki Akita
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AM, YH, and ZY: conception of the work, search of the literature, interpretation of the data, and drafting of the article. YH, and TD: critical revision of the article for important intellectual content. YZ and FT: critical revision of the article for important intellectual content and supervision of the work.

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Correspondence to Hiroaki Yanagimoto.

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Akita, M., Yanagimoto, H., Tsugawa, D. et al. Surgical interpretation of the WHO subclassification of intrahepatic cholangiocarcinoma: a narrative review. Surg Today (2024). https://doi.org/10.1007/s00595-024-02825-x

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