Z Gastroenterol 2019; 57(01): e37
DOI: 10.1055/s-0038-1677139
2. Clinical Hepatology, Surgery, LTX
Georg Thieme Verlag KG Stuttgart · New York

Liver Resection for Cholangiocarcinoma: Biological and Surgical Predictors of Outcome, Status Quo in Additive Therapy

A Nickkholgh
1   Department of General, Visceral, and Transplantation Surgery, University of Heidelberg
,
O GhamarNejad
1   Department of General, Visceral, and Transplantation Surgery, University of Heidelberg
,
E Khajeh
1   Department of General, Visceral, and Transplantation Surgery, University of Heidelberg
,
G Benjamin
2   Institute of Pathology, Ruprecht-Karls-University, Heidelberg, Germany
,
K Hoffmann
1   Department of General, Visceral, and Transplantation Surgery, University of Heidelberg
,
A Mehrabi
1   Department of General, Visceral, and Transplantation Surgery, University of Heidelberg
› Author Affiliations
Further Information

Publication History

Publication Date:
04 January 2019 (online)

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Background:

We aimed to analyze the outcome of liver resection for patients with intrahepatic cholangiocarcinoma (IHCCA), and to revisit the biological and surgical determinants of outcome, and the role of neoadjuvant and additive therapeutic modalities in our single-center cohort.

Methods:

We used a prospectively filled database of 190 consecutive patients undergoing surgery due to a preoperative diagnosis of IHCCA between December 2001 and December 2015. Demographic, anatomical, clinical, operative, surgical pathologic and follow-up data of all patients were analyzed.

Results:

Nineteen patients (10.2%) underwent neoadjuvant chemotherapy. The most frequent surgical approach was minor hepatectomy (≤3 segments) in 49 (25.7%), including three patients undergoing central liver resection (for Couinaud liver segments 4, 5, and 8), followed by left hemihepatectomy in 45 patients (23.7%). Locoregional lymphadenectomy was performed in 91 (48.1%) patients. Free surgical margin was achieved in 117 patients (64.6%). The 1-, 3-, and 5-year overal survival (OS) were 75%, 57%, and 38%, respectively. Recurrence was documented in 87 patients. The mean survival time after the documentation of recurrence was 16 ± 2 months. Age ≥65 years (hazard ratio [HR] 2.2, 95% confidence interval [CI] 1.2 – 4.0, p = 0.013), median tumor diameter of ≥5 cm (HR 3.0, 95%CI 1.4 – 6.2, p = 0.004), preoperative biliary drainage (HR 2.7, 95%CI 1.2 – 6.4, p = 0.021), and local R status (HR 2.0, 95%CI 1.1 – 3.7, p = 0.034) were the independent determinants of OS. Furthermore, median tumor diameter of ≥5 cm (HR 1.7, 95%CI 1.1 – 2.7, p = 0.020), high-grade (G3-G4) tumor (HR 1.6, 95%CI 1.0 – 2.5, p = 0.034), and local status R1 (HR 1.7, 95%CI 1.1 – 2.7, p = 0.002) were the independent determinants of disease-free survival.

Conclusions:

Hepatectomy remains the only curative treatment for patients with IHCCA. Additive therapeutic strategies to prolong disease-free survival are still ineffective. Further prospective studies are needed to improve the postoperative outcomes of IHCCA.