Complex Liver Resections for Intrahepatic Cholangiocarcinoma

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Gastroenterology

Background:

• Intrahepatic cholangiocarcinoma (iCCA) treatment relies on liver resection for cure.
• Complex liver resections are necessary for centrally located tumors or those with vascular invasion.
• Long-term outcomes of complex liver resections for iCCA remain largely unknown.

Purpose of the Study:

• To evaluate the long-term outcomes of complex liver resections in intrahepatic cholangiocarcinoma patients.
• To compare survival rates between complex and conventional liver resections for iCCA.
• To identify independent risk factors affecting survival in iCCA patients undergoing liver resection.

Main Methods:

• Retrospective cohort study of patients undergoing liver surgery for iCCA.
• Complex resections included ante situm resections, associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), and major resections with vascular reconstructions.
• Comparison of preoperative characteristics, postoperative complications, perioperative mortality, and long-term survival between complex and conventional resection groups.

Main Results:

• Thirty-four percent (49/143) of patients underwent complex liver resection.
• Complex resections were associated with increased postoperative complications and perioperative mortality.
• Long-term survival did not differ significantly between complex and conventional liver resection groups.
• R0 resections and Union for International Cancer Control (UICC) stage were independent risk factors for survival.

Conclusions:

• Complex liver resections are a viable option for selected iCCA patients.
• Survival outcomes after complex liver resections are comparable to conventional resections.
• iCCA survival is primarily influenced by resection margin status (R0) and UICC stage, not surgical complexity.