AGGRESSIVE SURGICAL-TREATMENT OF INTRAHEPATIC CHOLANGIOCARCINOMA - PREDICTORS OF OUTCOMES

Background: Intrahepatic cholangiocarcinoma (ICC) is the, second most common primary liver cancer and constitutes 10% of primary liver malig nancies. Surgery is the optimal therapy, the majority of the patients will require extensive resections that are associated with significant morbidity. Methods: We retrospectively studied the records of 26 pati ents who underwent exploratory laparotomy for intrahepatic cholangioca rcinoma between June 1991 and December 1997 at the Mount Sinai Hospita l. Patients with perihilar (Klatskin) tumors were excluded. All patien ts were considered resectable based on CT or MRI findings. Patients wi th positive margins or nodal invasion received adjuvant chemotherapy a nd radiation. Results: Sixteen patients underwent 18 resections; in 10 patients the tumors were unresectable at laparotomy and only biopsy w as performed. The mean age (62 versus 53 years) was significantly high er, and the mean total bilirubin level (0.71 versus 6.17 mg/dL) was si gnificantly lower in the resected group (p = 0.031 and 0.017, respecti vely). No patient with a total bilirubin over 1.2 mg/dL was found to b e resectable. Median actuarial survivals were 42.9 +/- 8.9 months for resectable and 6.7 +/- 3.6 months for unresectable patients (p = 0.005 ). Positive margins were associated with significantly shorter disease -free survival. But resected patients with positive margins survived s ignificantly longer than those who were unresectable. Tumor size, pres ence of satellite nodules, and degree of tumor necrosis on histologic examination were significant predictors of outcomes. Survival among pa tients receiving adjuvant therapy was not significantly altered. Concl usions: We conclude that an aggressive surgical approach is warranted in patients with ICC because resection offers the only hope for longte rm survival. Our findings emphasize the importance of achieving tumor- free margins. Noncurative resection offers a survival advantage over n o resection. Histologic examination of resected specimens can help sel ect patients with poor prognoses. (J Am Cell Surg 1998;187:365-372. (C ) 1998 by the American College of Surgeons).