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Surgical Resection Does Not Improve Survival in Multifocal Intrahepatic Cholangiocarcinoma: A Comparison of Surgical Resection with Intra-Arterial Therapies

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Multifocal intrahepatic cholangiocarcinoma (ICC) has traditionally been treated with surgical resection when amenable. Intra-arterial therapy (IAT) for multifocal ICC has not been directly compared with surgical resection.


A single-center, retrospective review of consecutive patients treated for multifocal ICC was conducted. Patients with distant metastases or treatment with systemic chemotherapy alone were excluded. Patients were divided into two groups: surgical resection versus IAT; IAT included transarterial chemoembolization (TACE), transarterial radioembolization (TARE), and hepatic arterial infusion (HAI) pump therapy. Subjects were also analyzed by surgical resection, TACE, and HAI pump therapy.


Overall, 116 patients with multifocal ICC were studied, 57 in the surgical resection group and 59 in the IAT group (TACE = 41, HAI pump = 16, TARE = 2). The IAT group was characterized by a higher incidence of bilobar disease (88.1% vs. 47.4%, p < 0.001), larger tumors (median 10.6 vs. 7.5 cm, p = 0.004), higher incidence of macrovascular invasion (44.1% vs. 24.6%, p = 0.027), and higher rate of nodal metastases (57.6% vs. 28.6%, p = 0.002). Median overall survival for surgical resection was 20 months versus 16 months for IAT (p = 0.627). Multivariate analysis found that macrovascular invasion [hazard ratio (HR) 2.52, 95% confidence interval (CI) 1.56–4.09] and non-receipt of systemic chemotherapy (HR 3.81, 95% CI 2.23–6.52) were independent poor prognostic risk factors. Surgical resection was not associated with a survival advantage over IAT on multivariate analysis (p = 0.242).


Despite selection bias for use of surgical resection compared with IAT, no survival advantage was conferred in the treatment of multifocal ICC.

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  1. Poultsides GA, Zhu AX, Choti MA, Pawlik TM. Intrahepatic cholangiocarcinoma. Surg Clin North Am. 2010;90:817–37.

    Article  PubMed  Google Scholar 

  2. Shaib YH, Davila JA, McGlynn K, El-Serag HB. Rising incidence of intrahepatic cholangiocarcinoma in the United States: a true increase? J Hepatol. 2004;40:472–77.

    Article  PubMed  Google Scholar 

  3. Valle J, Wasan H, Palmer DH, et al. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med. 2010;362:1273–81.

    Article  CAS  PubMed  Google Scholar 

  4. Mavros MN, Economopoulos KP, Alexiou VG, Pawlik TH. Treatment and prognosis for patients with intrahepatic cholangiocarcinoma: systematic review and meta-analysis. JAMA Surg. 2014;149:565–74.

    Article  PubMed  Google Scholar 

  5. Wang Y, Li J, Xia Y, et al. Prognostic nomogram for intrahepatic cholangiocarcinoma after partial hepatectomy. J Clin Oncol. 2013;31:1188–95.

    Article  PubMed  Google Scholar 

  6. Hyder O, Marques H, Pulitano C, et al. A nomogram to predict long-term survival after resection for intrahepatic cholangiocarcinoma: an Eastern and Western experience. JAMA Surg. 2014;149:432–37.

    Article  PubMed  Google Scholar 

  7. Doussot A, Groot-Koerkamp B, Wiggers JK, et al. Outcomes after resection of intrahepatic cholangiocarcinoma: external validation and comparison of prognostic models. J Am Coll Surg. 2014;221:452–61.

    Article  Google Scholar 

  8. 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. 2014;22:2218–25.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Endo I, Gonen M, Yopp AC, et al. Intrahepatic cholangiocarcinoma: frequency, improved survival, and determinants of outcome after resection. Ann Surg. 2008;248:84–96.

    Article  PubMed  Google Scholar 

  10. Uenishi T, Arrizumi S, Aoki T, et al. Proposal of a new staging system for mass-forming intrahepatic cholangiocarcinoma: a multicenter analysis by the Study Group for Hepatic Surgery of the Japanese Society of Hepato-Biliary-Pancreatic Surgery. J Hepatobiliary Pancreat Sci. 2014;21:499–508.

    Article  PubMed  Google Scholar 

  11. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.

    Article  CAS  PubMed  Google Scholar 

  12. Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45:228–47.

    Article  CAS  PubMed  Google Scholar 

  13. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Weber SM, Ribero D, O’Reilly EM, Kokudo N, Miyazaki M, Pawlik TM. Intrahepatic cholangiocarcinoma: expert consensus statement. HPB. 2015;17:669–80.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Abou-Alfa GK, Geschwind JF, Choti M, D’Angelica MI. Consensus conference on intrahepatic cholangiocarcinoma. HPB. 2015;17:661–63.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Konstantinidis IT, Do RKG, Gultekin DH, et al. Regional chemotherapy for unresectable intrahepatic cholangiocarcinoma: a potential role for dynamic magnetic resonance imaging as an imaging biomarker and a survival update from two prospective clinical trials. Ann Surg Oncol. 2014;21:2675–83.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Dhir M, Zenati MS, Padussis JC, et al. Robotic assisted placement of hepatic artery infusion pump is a safe and feasible approach. J Surg Oncol. 2016;114:342–47.

    Article  CAS  PubMed  Google Scholar 

  18. Miura JT, Johnston FM, Tsai S, et al. Chemotherapy for surgically resected intrahepatic cholangiocarcinoma. Ann Surg Oncol. 2015;22:3716–23.

    Article  PubMed  Google Scholar 

  19. Sur MD, In H, Sharpe SM, Baker MS, Weichselbaum RR, Talamonti MS, et al. Defining the benefit of adjuvant therapy following resection for intrahepatic cholangiocarcinoma. Ann Surg Oncol. 2015;22:2209–17.

    Article  PubMed  Google Scholar 

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G Paul Wright, Samantha Perkins, Heather Jones, Amer H. Zureikat, J. Wallis Marsh, Matthew P. Holtzman, Herbert J. Zeh III, David L. Bartlett, and James F. Pingpank Jr have no conflicts of interest to disclose.

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Correspondence to James F. Pingpank Jr. MD.

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Wright, G.P., Perkins, S., Jones, H. et al. Surgical Resection Does Not Improve Survival in Multifocal Intrahepatic Cholangiocarcinoma: A Comparison of Surgical Resection with Intra-Arterial Therapies. Ann Surg Oncol 25, 83–90 (2018).

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