Correlation between tumor size and mode of spread in mass-forming intrahepatic cholangiocarcinoma

Mode of spread of intrahepatic cholangiocarcinoma of the mass-forming type (MF-ICC) has not been assessed according to tumor size.

We retrospectively evaluated 17 cases of resected MF-ICCs. Tumor size was categorized as follows: < 45 mm (n=4), 45-79 mm (n=7), and > or = 80 mm (n=6). The correlation of tumor size with presence or absence of histological invasion to the portal vein (vp), hepatic vein (vv), intrahepatic metastasis (im), and lymphatic vessel or perineural space (ly/pn) was evaluated. Clinical outcomes of 13 patients who underwent curative resection were also investigated.

The positive rates of vp, vv, im, and ly/pn were calculated as 25, 0, 0, and 0% in the < 45-mm group; 86, 29, 86, and 71% in the 45-79-mm group; and 100, 50, 83, and 83% in the > or = 80-mm group, respectively. Of 13 patients who underwent curative resection, 6 of 9 in the > 45-mm group were found to have recurrent diseases in the liver remnant, lymph node, and the lung, whereas one of 4 patients in the < 40-mm group developed peritoneal recurrence.

Systematic hepatectomy without lymphadenectomy might be appropriate for MF-ICC smaller than 45 mm in diameter.