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Is Hepatic Resection for Large or Multifocal Intrahepatic Cholangiocarcinoma Justified? Results from a Multi-Institutional Collaboration

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The role of surgical resection for patients with large or multifocal intrahepatic cholangiocarcinoma (ICC) remains unclear. This study evaluated the long-term outcome of patients who underwent hepatic resection for large (≥7 cm) or multifocal (≥2) ICC.

Methods

Between 1990 and 2013, 557 patients who underwent liver resection for ICC were identified from a multi-institutional database. Clinicopathologic characteristics, operative details, and long-term survival data were evaluated.

Results

Of the 557 patients, 215 (38.6 %) had a small, solitary ICC (group A) and 342 (61.4 %) had a large or multifocal ICC (group B). The patients in group B underwent an extended hepatectomy more frequently (16.9 vs. 30.4 %; P < 0.001). At the final pathology exam, the patients in group B were more likely to show evidence of vascular invasion (22.5 vs. 38.5 %), direct invasion of contiguous organs (6.5 vs. 12.9 %), and nodal metastasis (13.3 vs. 21.0 %) (all P < 0.05). Interestingly, the incidences of postoperative complications (39.3 vs. 46.8 %) and hospital mortality (1.1 vs. 3.7 %) were similar between the two groups (both P > 0.05). The group A patients had better rates for 5-year overall survival (OS) (30.5 vs. 18.7 %; P < 0.05) and disease-free survival (DFS) (22.6 vs. 8.2 %; P < 0.05) than the group B patients. For the patients in group B, the factors associated with a worse OS included more than three tumor nodules [hazard ratio (HR), 1.56], nodal metastasis (HR, 1.47), and poor differentiation (HR, 1.48).

Conclusions

Liver resection can be performed safely for patients with large or multifocal ICC. The long-term outcome for these patients can be stratified on the basis of a prognostic score that includes tumor number, nodal metastasis, and poor differentiation.

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Acknowledgment

The authors thank Donielle Neal, Maria Knoblich, Mafalda Sobral, Eduardo Barroso, Jorge Lamelas, Susana Rodrigues, Francesca Ratti, and Stéphanie Meyer.

Conflict of interest

There are no conflicts of interest.

Author information

Authors and Affiliations

  1. The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Gaya Spolverato MD, Yuhree Kim MD, MPH & Timothy M. Pawlik MD, MPH, PhD

  2. Fundeni Clinical Institute, Bucharest, Romania

    Sorin Alexandrescu MD & Irinel Popescu MD

  3. Curry Cabral Hospital, Lisbon, Portugal

    Hugo P. Marques MD

  4. Ospedale San Raffaele, Milan, Italy

    Luca Aldrighetti MD

  5. Medical College of Wisconsin, Milwaukee, WI, USA

    T. Clark Gamblin MD & John Miura MD

  6. Emory University, Atlanta, GA, USA

    Shishir K. Maithel MD & Malcolm H. Squires MD

  7. University of Sydney, Sydney, Australia

    Carlo Pulitano MD & Charbel Sandroussi MD

  8. Hôpitaux Universitaires de Genève, Geneva, Switzerland

    Gilles Mentha MD

  9. University of Virginia, Charlottesville, VA, USA

    Todd W. Bauer MD & Timothy Newhook MD

  10. Eastern Hepatobiliary Surgery Hospital, Shanghai, China

    Feng Shen MD

  11. Stanford University, Stanford, CA, USA

    George A. Poultsides MD

  12. University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    J. Wallis Marsh MD

  13. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA

    Timothy M. Pawlik MD, MPH, PhD

Authors
  1. Gaya Spolverato MD
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  2. Yuhree Kim MD, MPH
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  3. Sorin Alexandrescu MD
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  4. Irinel Popescu MD
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  5. Hugo P. Marques MD
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  6. Luca Aldrighetti MD
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  7. T. Clark Gamblin MD
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  8. John Miura MD
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  9. Shishir K. Maithel MD
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  10. Malcolm H. Squires MD
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  11. Carlo Pulitano MD
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  12. Charbel Sandroussi MD
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  13. Gilles Mentha MD
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  14. Todd W. Bauer MD
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  15. Timothy Newhook MD
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  16. Feng Shen MD
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  17. George A. Poultsides MD
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  18. J. Wallis Marsh MD
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  19. Timothy M. Pawlik MD, MPH, PhD
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Corresponding author

Correspondence to Timothy M. Pawlik MD, MPH, PhD.

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Spolverato, G., Kim, Y., Alexandrescu, S. et al. Is Hepatic Resection for Large or Multifocal Intrahepatic Cholangiocarcinoma Justified? Results from a Multi-Institutional Collaboration. Ann Surg Oncol 22, 2218–2225 (2015). https://doi.org/10.1245/s10434-014-4223-3

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  • DOI: https://doi.org/10.1245/s10434-014-4223-3

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