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Impact of Tumor Subclassifications for Identifying an Appropriate Surgical Strategy in Patients with Intrahepatic Cholangiocarcinoma

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

Abstract

Background

Intrahepatic cholangiocarcinoma (ICC) is subclassified into small and large duct types. The impact of these subclassifications for identifying appropriate surgical strategies remains unclear.

Patients and Methods

This study included 118 patients with ICC who underwent liver resection. Based on the pathological examination results, the participants were divided into the small duct-type ICC group (n = 64) and large duct-type ICC group (n = 54). The clinicopathological features and postoperative outcomes were compared between the two groups to investigate the impact of subclassification for selecting appropriate surgical strategies.

Results

Ten patients in the small duct-type ICC group had synchronous or metachronous hepatocellular carcinoma. The large duct-type ICC group had higher proportions of patients who underwent major hepatectomy, extrahepatic bile duct resection, portal vein resection, and lymph node sampling or dissection than the small duct-type ICC group. The large duct-type ICC group had significantly higher incidences of lymph node metastasis/recurrence and pathological major vessel invasion than the other. The small duct-type ICC group exhibited significantly higher recurrence-free and overall survival rates than the large duct-type ICC group. Further, the large duct-type ICC group had a significantly higher incidence of lymph node metastasis/recurrence than the small duct-type ICC at the perihilar region group.

Conclusions

Suitable surgical strategies may differ between the small and large duct-type ICCs. In patients with large duct-type ICCs, hepatectomy with lymph node dissection and/or biliary reconstruction should be considered, whereas hepatectomy without these advanced procedures can be suggested for patients with small duct-type ICCs.

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Acknowledgement

This work was supported by JSPS KAKENHI, grant number JP 22K16495.

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Authors and Affiliations

  1. Department of Hepato-Biliary-Pancreatic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan

    Masahiko Kinoshita MD, PhD, Hiroji Shinkawa MD, PhD, Kenjiro Kimura MD, PhD, Go Ohira MD, PhD, Kohei Nishio MD, PhD, Ryota Tanaka MD, PhD, Shigeaki Kurihara MD, Shuhei Kushiyama MD, PhD, Naoki Tani MD, Takahito Kawaguchi MD, Takeaki Ishizawa MD, PhD & Shoji Kubo MD, PhD

  2. Department of Human Pathology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan

    Yasunori Sato MD, PhD

  3. Department of Radiology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan

    Akira Yamamoto MD, PhD

  4. Health Education Course, Department of Education, Faculty of Education, Shitennoji University, Habikino, Osaka, Japan

    Shoji Kubo MD, PhD

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  1. Masahiko Kinoshita MD, PhD
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Correspondence to Masahiko Kinoshita MD, PhD.

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Kinoshita, M., Sato, Y., Shinkawa, H. et al. Impact of Tumor Subclassifications for Identifying an Appropriate Surgical Strategy in Patients with Intrahepatic Cholangiocarcinoma. Ann Surg Oncol 31, 2579–2590 (2024). https://doi.org/10.1245/s10434-023-14833-1

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