T. Yoh1, E. Hatano1, K. Yamanaka1, S. Satoru1, T. Nitta1, S. Uemoto1 1Kyoto University,Division Of Hepatobiliary Pancreatic Surgery And Transplantation,Department Of Surgery, Graduate School Of Medicine, Kyoto University,Kyoto, KYOTO, Japan
Introduction:
European Association for the Study of Liver (EASL) guidelines for the diagnosis and management of intrahepatic cholangiocarcinoma (iCCA) recommended that patients demonstrating intrahepatic metastases (IM), vascular invasion (VI) or lymph node metastases (LM) should not undergo resection. The aim of this study was to evaluate the validity of surgical justification for iCCA with IM, VI, or LM
Methods:
One hundred fifty-five patients who underwent hepatectomy for ICC from 1993 to 2013 in Kyoto University hospital were enrolled. Overall survival stratified with IM, VI and LM, and other prognosis factors for survival were analyzed
Results:
The median survival time (MST) of all patients was 27.8 months (M). MST was 18.7 versus 41.7 month in IM +/- (p<0.001), 16.9 versus 35.9 month in VI +/- (p=0.017), and 12.5 versus 46.1 month in LM +/- (p<0.001), respectively. Multivariate analysis demonstrated that CA19-9, LM, VI and perioperative gemcitabine-based chemotherapy were independent prognostic factors for survival. Subgroup analysis showed perioperative chemotherapy improved survival in patients with VI (37.4M) or LM (35.9M), but not IM (18.7M)
Conclusion:
Although prognosis of iCCA patients with IM, VI or LM was poor, perioperative chemotherapy might improve prognosis. Surgical resection can be justified for iCCA with IM, VI, or LM, if curative resection and following chemotherapy are possible