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Outcome and Prognosis After Resection of Intrahepatic Cholangiocarcinoma: Single Center Series of 79 Patients
Hannes P. Neeff*1, Philipp A. Holzner1, Andrea Klock1, Peter Bronsert2, Ulrich T. Hopt1, Frank Makowiec1
1Department of Surgery, University of Freiburg, Freiburg, Germany; 2Department of Pathology, University of Freiburg, Freiburg, Germany
Introduction: Intrahepatic cholangiocarcinoma (ICC) is a rare entity. In the western world the incidence is below one in 100.000. Yet, there has been a sharp increase over the past 30 years, more than doubling the incidence. Diagnosis is often delayed due to oligosymptomatic growth. Survival is poor and non surgical treatment options are limited. Surgical resection is the only chance for cure. In order to select good surgical candidates, robust prognostic factors are needed.
Methods: Patients undergoing potentially curative liver resection for ICC since 2001 were identified from our prospective hepatic database. Patients undergoing biopsy only, and patients with hilar or distal cholangiocarcinoma were excluded from the analysis. Outcome and prognostic factors were assessed by actuarial survival analysis including Kaplan-Meier and Cox Proportional Hazard methods.
Results: 54% of patients were male, median age was 65 years (range 33-83). 81% of the patients underwent major hepatectomy (hemihepatectomy or >4 segments). 29 % had multicentric tumors. In 56% the tumor diameter was > 60mm. Free margins were obtained in 77 %. Median postoperative follow up was 1.8 years (0-8.8).
5-year overall survival was 26 % (median survival 2.8 years). In univariate analysis survival was significantly influenced by the resection margin, nodal status, tumor grading, number of tumors (one vs > one), T stage and the presence of (intrahepatic) metastasis (all p <0.01). Tumor size (cut-off 60mm), and gender did not influence survival. Multivariate analysis showed significantly worse survival for nodal positive tumors (p<0.02, HR 2.7 (CI 1.2-6.2)), (intrahepatic) metastases (p<0.22, HR 3.3 (CI 1.2-9.1)) and T stage >2 (p<0.16 HR 2.4 (CI 1.2-4.8))
Conclusions: Poorly differentiated multicentric ICC with positive nodes have a very poor prognosis, even after complete resection. However, following standard surgical criterias of resectability, an attempt to surgical treatment should always be made.
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