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Surgical treatment of cholangiocellular carcinoma

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Abstract

Intrahepatic cholangiocellular carcinoma (CCC) is known to be associated with severe symptoms and a particularly poor prognosis. Nonsurgical methods have failed to change this situation up to now. Surgical therapy, so far, is the only chance for effective treatment, but it has had limited success. The relative infrequency of this tumor does not allow extensive statistics and limits our present knowledge. In this contribution the outcome of 50 patients who underwent liver resection or liver transplantation in our institution is reported. Their courses have been reevaluated according to pathohistologic classification and TNM tumor staging. The median survival rates were 12.8 months in the group of patients after liver resection (n=32) and 5.0 months after liver transplantation (n=18). Liver transplantation, however, was performed only in patients with unresectable tumors. The longest survival after transplantation was 25 months; after resection four patients survived more than 5 years. In the resection group and the transplantation group survival rates correlated with tumor size and tumor stages according to TNM, although the differences were not statistically significant. Liver resection thus has its place in resectable situations. Liver transplantation for unresectable lesions of this tumor type—always deemed critically in the past—seems not to be indicated with our present stage of knowledge, unless adjuvant protocols appear promising and are tested.

Résumé

Le cholangiocarcinome donne des symptômes sévères et est associé à un prognostic particulièrement mauvais. Le traitement non chirurgical est inopérant. La chirurgie, jusqu'à présent, est la seule chance de traitement efficace quoi que les succès sont très limités. La faible fréquence de cette tumeur ne permet pas d'accumuler des statistiques valables, et ceci limite l'état de nos connaissances actuelles. L'évolution chez 50 patients ayant eu une résection ou une transplantation a été analysée en fonction de leur classifications anatomopathologique et TNM. La survie médiane était de 12.8 mois chez le groupe de patients ayant eu une résection (n=32) et de 5.0 mois après la transplantation hépatique (n=18). La transplantation cependant, a été réalisée chez les patients où la résection était impossible. La survie la plus longue après transplantation a été de 25 mois. Quatre patients ont survécu plus de 5 ans après résection. La survie était corrélée avec la taille de la tumeur et le stade TNM, mais sans signification statistique. La résection hépatique est donc valable pour ces tumeurs. En cas de lésion non résequable, la transplantation ne semble pas être une solution valable.

Resumen

El carcinoma colangiocelular intrahepático (CCC) se caracteriza por severa sintomatología y muy mal pronóstico. Hasta el presente, los métodos terapéuticos no quirúrgicos han demostrado incapacidad de modificar tal situación. El tratamiento quirúrgico aun constituye la única modalidad eficaz, pero con éxito limitado. La rareza de este tumor no ha permitido acumular estadísticas numerosas, limitando nuestro conocimiento de la enfermedad. En este trabajo se presentan los resultados en 50 pacientes sometidos a resección hepática o a trasplante de hígado en nuestra institución, valorándolos según clasificación histopatológica y estadificación TNM del tumor. Las tasas medias de sobrevida fueron 12.8 meses en el grupo de pacientes con resección hepática (n=32) y 5.0 meses después de trasplante de hígado (n=18). El trasplante de hígado, sin embargo, fue realizado únicamente en situaciones de irresecabilidad. La myor supervivencia luego de trasplante fue 25 meses; entre los sometidos a resección, 4 pacientes sobrevivieron más de 5 años. Las tasas de sobrevida se correlacionaron, tanto en el grupo de resección como en el de trasplante, con el tamaño del tumor y con la estadificación TNM, aunque las diferencias no fueron estadísticamente significativas. La resección hepática, incluyendo cirugía mayor, tiene indicación en pacientes con tumores resecables. El trasplante en los pacientes con tumores no resecables no parece estar indicado, a la luz del conocimiento actual, a menos que protocolos coadyuvantes, debidamente probados, aporten resultados promisorios.

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Authors and Affiliations

  1. Klinik für Abdominal- und Transplantationschirurgie, Medizinische Hochschule Hannover, Konstanty-Gutschow-Strasse 8, 30625, Hannover, Germany

    Rudolf Pichlmayl M.D., Peter Lamesch M.D., Arved Weimann M.D., Günter Tusch M.S. & Burkhardt Ringe M.D.

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  1. Rudolf Pichlmayl M.D.
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  2. Peter Lamesch M.D.
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  3. Arved Weimann M.D.
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  4. Günter Tusch M.S.
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  5. Burkhardt Ringe M.D.
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Pichlmayl, R., Lamesch, P., Weimann, A. et al. Surgical treatment of cholangiocellular carcinoma. World J. Surg. 19, 83–88 (1995). https://doi.org/10.1007/BF00316984

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