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

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Journal of Gastrointestinal Surgery Aims and scope

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.

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Acknowledgements

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

Author information

Authors and Affiliations

  1. Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China

    Xu-Feng Zhang

  2. Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA

    Xu-Feng Zhang, Jeffery Chakedis, Dimitrios Moris, Eliza W. Beal, Alfredo Guglielmi & Timothy M. Pawlik

  3. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA

    Fabio Bagante & Matthew Weiss

  4. Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania

    Irinel Popescu

  5. Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal

    Hugo P. Marques

  6. Department of Surgery, Ospedale San Raffaele, Milan, Italy

    Luca Aldrighetti

  7. Department of Surgery, Emory University, Atlanta, GA, USA

    Shishir K. Maithel

  8. Department of Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia

    Carlo Pulitano

  9. Department of Surgery, University of Virginia, Charlottesville, VA, USA

    Todd W. Bauer

  10. Department of Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China

    Feng Shen

  11. Department of Surgery, Stanford University, Stanford, CA, USA

    George A. Poultsides

  12. Department of Hepatobiliopancreatic Surgery and Liver Transplantation, AP-HP, Beaujon Hospital, Clichy, France

    Oliver Soubrane

  13. Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada

    Guillaume Martel

  14. Department of Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands

    B. Groot Koerkamp

  15. Gastroenterological Surgery Division, Yokohama City University School of Medicine, Yokohama, Japan

    Endo Itaru

Authors
  1. Xu-Feng Zhang
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  2. Fabio Bagante
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  18. Alfredo Guglielmi
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  20. Timothy M. Pawlik
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Corresponding author

Correspondence to Timothy M. Pawlik.

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Zhang, XF., Bagante, F., Chakedis, J. et al. Perioperative and Long-Term Outcome for Intrahepatic Cholangiocarcinoma: Impact of Major Versus Minor Hepatectomy. J Gastrointest Surg 21, 1841–1850 (2017). https://doi.org/10.1007/s11605-017-3499-6

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  • DOI: https://doi.org/10.1007/s11605-017-3499-6

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