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Journal of Gastrointestinal Surgery

, Volume 21, Issue 11, pp 1841–1850 | Cite as

Perioperative and Long-Term Outcome for Intrahepatic Cholangiocarcinoma: Impact of Major Versus Minor Hepatectomy

  • Xu-Feng Zhang
  • Fabio Bagante
  • Jeffery Chakedis
  • Dimitrios Moris
  • Eliza W. Beal
  • Matthew Weiss
  • Irinel Popescu
  • Hugo P. Marques
  • Luca Aldrighetti
  • Shishir K. Maithel
  • Carlo Pulitano
  • Todd W. Bauer
  • Feng Shen
  • George A. Poultsides
  • Oliver Soubrane
  • Guillaume Martel
  • B. Groot Koerkamp
  • Alfredo Guglielmi
  • Endo Itaru
  • Timothy M. PawlikEmail author
Original Article

Abstract

Background

The objective of the current study was to investigate both short- and long-term outcomes of patients undergoing curative-intent resection for intrahepatic cholangiocarcinoma (ICC) stratified by extent of hepatic resection relative to overall final pathological margin status.

Methods

One thousand twenty-three patients with ICC who underwent curative-intent resection were identified from a multi-institutional database. Demographic, clinicopathological, and operative data, as well as overall (OS) and recurrence-free survival (RFS) were compared among patients undergoing major and minor resection before and after propensity score matching.

Results

Overall, 608 (59.4%) patients underwent major hepatectomy, while 415 (40.6%) had a minor resection. Major hepatectomy was more frequently performed among patients who had large, multiple, and bilobar tumors. Roughly half of patients (n = 294, 48.4%) developed a postoperative complication following major hepatectomy versus only one fourth of patients (n = 113, 27.2%) after minor resection (p < 0.001). In the propensity model, patients who underwent major hepatectomy had an equivalent OS and RFS versus patients who had a minor hepatectomy (median OS, 38 vs. 37 months, p = 0.556; and median RFS, 20 vs. 18 months, p = 0.635). Patients undergoing major resection had comparable OS and RFS with wide surgical margin (≥10 and 5–9 mm), but improved RFS when surgical margin was narrow (1–4 mm) versus minor resection in the propensity model. In the Cox regression model, tumor characteristics and surgical margin were independently associated with long-term outcome.

Conclusions

Major hepatectomy for ICC was not associated with an overall survival benefit, yet was associated with increased perioperative morbidity. Margin width, rather than the extent of resection, affected long-term outcomes. Radical parenchymal-sparing resection should be advocated if a margin clearance of ≥5 mm can be achieved.

Keywords

Intrahepatic cholangiocarcinoma Major Minor Hepatectomy Outcomes 

Notes

Acknowledgements

X.-F. Z. was supported in part by the China Scholarship Council.

Supplementary material

11605_2017_3499_MOESM1_ESM.docx (12 kb)
Supplementary Table 1 (DOCX 12 kb)
11605_2017_3499_MOESM2_ESM.docx (15 kb)
Supplementary Table 2 (DOCX 15 kb)
11605_2017_3499_MOESM3_ESM.docx (267 kb)
Supplementary Fig. 1 (DOCX 266 kb)

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Copyright information

© The Society for Surgery of the Alimentary Tract 2017

Authors and Affiliations

  • Xu-Feng Zhang
    • 1
    • 2
  • Fabio Bagante
    • 3
  • Jeffery Chakedis
    • 2
  • Dimitrios Moris
    • 2
  • Eliza W. Beal
    • 2
  • Matthew Weiss
    • 3
  • Irinel Popescu
    • 4
  • Hugo P. Marques
    • 5
  • Luca Aldrighetti
    • 6
  • Shishir K. Maithel
    • 7
  • Carlo Pulitano
    • 8
  • Todd W. Bauer
    • 9
  • Feng Shen
    • 10
  • George A. Poultsides
    • 11
  • Oliver Soubrane
    • 12
  • Guillaume Martel
    • 13
  • B. Groot Koerkamp
    • 14
  • Alfredo Guglielmi
    • 2
  • Endo Itaru
    • 15
  • Timothy M. Pawlik
    • 2
    Email author
  1. 1.Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and EngineeringThe First Affiliated Hospital of Xi’an Jiaotong UniversityXi’anChina
  2. 2.Department of SurgeryThe Ohio State University Wexner Medical CenterColumbusUSA
  3. 3.Department of SurgeryJohns Hopkins HospitalBaltimoreUSA
  4. 4.Department of SurgeryFundeni Clinical InstituteBucharestRomania
  5. 5.Department of SurgeryCurry Cabral HospitalLisbonPortugal
  6. 6.Department of SurgeryOspedale San RaffaeleMilanItaly
  7. 7.Department of SurgeryEmory UniversityAtlantaUSA
  8. 8.Department of SurgeryRoyal Prince Alfred Hospital, University of SydneySydneyAustralia
  9. 9.Department of SurgeryUniversity of VirginiaCharlottesvilleUSA
  10. 10.Department of SurgeryEastern Hepatobiliary Surgery HospitalShanghaiChina
  11. 11.Department of SurgeryStanford UniversityStanfordUSA
  12. 12.Department of Hepatobiliopancreatic Surgery and Liver TransplantationAP-HP, Beaujon HospitalClichyFrance
  13. 13.Division of General Surgery, Department of SurgeryUniversity of OttawaOttawaCanada
  14. 14.Department of SurgeryErasmus University Medical CentreRotterdamNetherlands
  15. 15.Gastroenterological Surgery DivisionYokohama City University School of MedicineYokohamaJapan

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