Clinical value of surgical resection for hilar type intrahepatic cholangiocarcinoma

Abstract:

Background and Aims Hilar type intrahepatic cholangiocarcinoma (HICC) is characterized by strong invasion capability and pathophysiological complexity. Surgical resection is the preferred treatment, but the R₀ resection rate remains low and the prognosis is poor. This study was conducted to assess the clinical value of surgical treatment of HICC by analyzing the outcomes of HICC patients treated by surgery.Methods The clinical and pathological data of 98 patients who underwent surgery for HICC in Eastern Hepatobiliary Surgery Hospital from November 2011 to June 2016 were retrospectively analyzed. Of the patients, 67 cases underwent radical surgery, and 31 cases were subjected to palliative surgery that included R₁ resection in 3 cases and R₂ resection in 28 cases. In patients undergoing radical surgery, hilar vascular invasion (HVI) occurred in 32 cases, and HVI did not occur in 35 cases.Results In the entire group of patients, the overall 1-, 3-, and 5-year survival rates were 46.5%, 11.7%, and 5.8%, respectively, with a median overall survival（mOS）of 12.0 months. Patients receiving radical surgery had a better prognosis than those undergoing palliative surgery (mOS: 14.0 months vs. 7.0 months, P=0.004). Patients without HVI showed a better prognosis compared with those with HVI (mOS: 21.0 months vs. 9.0 months, P=0.002) as well as those undergoing palliative surgery group (mOS: 21.0 months vs. 7.0 months, P<0.001). There was no difference in prognosis between patients with HVI undergoing radical surgery and those undergoing palliative surgery (mOS: 9.0 months vs. 7.0 months, P=0.192). Results of multivariate Cox analysis showed that HVI and high CA19-9 level were independent risk factors for the prognosis of HICC patients after radical surgery. Comparison between patients with and without HVI found that the patients with age > 60 years and tumor diameter ≥ 5 cm had a higher rate of HVI (both P<0.05).Conclusion The resection rate of HICC is low and the prognosis is poor. HVI and high CA19-9 level are risk factors for the prognosis of HICC patients after radical resection. Surgery offers no survival benefit to those with HVI.