Journal of Gastroenterology

, Volume 41, Issue 9, pp 893–900

Predictive factors for intrahepatic cholangiocarcinoma recurrence in the liver following surgery

  • Shiro Miwa
  • Shinichi Miyagawa
  • Akira Kobayashi
  • Yasuhiko Akahane
  • Takenari Nakata
  • Motohiro Mihara
  • Kei Kusama
  • Junpei Soeda
  • Shinichiro Ogawa
Article
  • 235 Downloads

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 

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Copyright information

© Springer-Verlag Tokyo 2006

Authors and Affiliations

  • Shiro Miwa
    • 1
  • Shinichi Miyagawa
    • 1
  • Akira Kobayashi
    • 1
  • Yasuhiko Akahane
    • 1
  • Takenari Nakata
    • 1
  • Motohiro Mihara
    • 1
  • Kei Kusama
    • 1
  • Junpei Soeda
    • 1
  • Shinichiro Ogawa
    • 1
  1. 1.Department of SurgeryShinshu University School of MedicineMatsumotoJapan

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