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2007 Program and Abstracts | 2007 Posters
Aggressive Hepatic Resection Improves Outcome of Intrahepatic Cholangiocarcinoma
Swee H. Teh*1, D. Cusati1, L. Chang2, E. Aboian1, S. Cha3, L. Burgart2, J. Donohue1, David M. Nagorney1
1Surgery, Mayo Clinic, Rochester, MN; 2Pathology, Mayo Clinic, Rochester, MT; 3Biostatistics, Mayo Clinic, Rochester, MT

Introduction.Intrahepatic cholangiocarcinoma (ICC) is a rare primary malignancy of the liver. The incidence and mortality rate of ICC is increasing world wide. We hypothesized that aggressive hepatic resection may improve the survival of patients with ICC.Methods.All consecutive patients that had undergone hepatic resection for ICC from Jan 1993 to Jan 2003 were retrospectively reviewed. All pathological specimens and additional 11 histological parameters were re-examined by two independent pathologists that were unaware of patient's clinical status.Results.There were 67 patients, 28 male and 39 female, with the mean age of 61 year old. Underlying liver disease was present in 16 patients (cirrhosis 4, HCB & HCV 6, PSC 1, others 5). There were 8 minor and 59 major hepatic resections which included 21 extended hepatic resection. Six patients had concurrent resection and reconstruction of extrahepatic structure (vena cava in 2, main portal vein in 2 and common bile duct in 2). There were 58 R0, nine R1 and no R2 resection. Six patients have microscopic positive margin despite extended hepatic resection. All patients had regional lymphadenectomy. The mean tumor size was 8 cm with 17 patients had lymph node metastasis. Tumor stage was T1 in 9, T2 in 11, T3 in 39 and T4 in 8 patients. One patient (1.5%) died perioperatively. Multivariable analysis demonstrated that the factors that significantly predict survival were major vascular invasion (0.0001), positive lymph node (0.0002), elevated alkaline phosphates level (0.001), T-stage (0.006), the presence of tumor necrosis (0.03) and R0 resection (0.04). The overall 1, 3, 5 years survival rate for R0 and R1 resection was (84% vs. 67%), (60% vs. 33%) and (48% vs. 11%), respectively. Disease recurrence occurs in 35 patients (53%) after mean follow up of 3.9 years. The 1, 3, 5 year disease free survival rate were 72%, 50% and 23%.Conclusions.Tumor factors are critical predictors of long term outcome. Aggressive hepatic resection, however, can provide long term survival in patients with intrahepatic cholangiocarcinoma. Future innovative multimodality therapy is needed to further enhance the survival following hepatic resection.

2007 Program and Abstracts | 2007 Posters
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