Related Experiment Video
Updated: Jan 18, 2026
Laparoscopic Anatomic S7+S8d Resection Preserving Inferior Right Hepatic Vein and S6 with Right Hepatic Vein Transection
Published on: December 30, 2025
Vascular resection and reconstruction in surgery for advanced intrahepatic cholangiocarcinoma - single center
Hauke Lang1, Lisa-Katharina Gröger1, Beate K Straub2
1Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
Insights
Hepatectomy with vascular resection for intrahepatic cholangiocarcinoma (iCCA) is feasible, offering a 20% 5-year survival rate. Suspected vascular invasion alone should not preclude resection, though biliary reconstruction increases mortality risk.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Gastroenterology
Background:
- Major vascular involvement in intrahepatic cholangiocarcinoma (iCCA) often contraindicates resection.
- Limited data exists on hepatectomy with vascular resection and reconstruction outcomes.
Purpose of the Study:
- To assess perioperative and long-term outcomes of hepatectomy combined with vascular resection and reconstruction for iCCA.
- To evaluate the impact of vascular resections on patient outcomes in a high-volume center.
Main Methods:
- Retrospective analysis of 345 patients undergoing surgical exploration for iCCA (2008-2023).
- Evaluation of 41 patients (16%) requiring 59 vascular resections (portal vein, hepatic veins, IVC) with reconstruction.
- Analysis of factors associated with vascular resection and impact on survival and recurrence.
Main Results:
- Vascular resection was associated with higher 90-day mortality (15% vs. 6%), with biliary reconstruction as a key risk factor.
- Median overall survival was 17 months with vascular resection versus 25 months without; recurrence-free survival was similar.
- Histological confirmation of vascular invasion was found in 37% of resected vessels; 5-year survival reached 20%.
Conclusions:
- Suspected vascular involvement in iCCA should not be an absolute contraindication to resection, given the potential for survival benefit.
- Caution is advised when hepaticojejunostomy is required due to increased mortality risk.
- Further research is needed on outcomes following neoadjuvant therapy in these patients.
Abstract:
Major vascular involvement in intrahepatic cholangiocarcinoma (iCCA) is often considered a relative contraindication to resection, resulting in limited data on hepatectomy with vascular resection and reconstruction. This study aimed to assess perioperative and long-term outcomes of hepatectomy combined with vascular resection and reconstruction in a high volume single center. We retrospectively analyzed all patients undergoing surgical exploration for iCCA between 2008 and 2023, with follow-up through January 2025. Data were evaluated for vascular resections involving the portal vein, major hepatic veins, or inferior vena cava, and their impact on outcomes. Among 345 explored patients, 265 (77 %) underwent resection with curative intent; 41 (16 %) required 59 vascular resections with reconstruction. Factors significantly associated with vascular resection included extent of hepatectomy, nodal status, tumor grading, and UICC stage. Vascular invasion was confirmed histologically in 37 % of resected vessels. Ninety-day mortality was higher in the vascular resection group (15 % vs. 6 %), with biliary reconstruction identified as a key mortality risk factor. Median overall survival was 17 months for vascular resection patients versus 25 months without. Recurrence-free survival was similar between groups. Within the vascular resection group, macrovascular invasion was associated with worse survival (11 vs. 25 months). The 5-year survival rate was 20 %, exceeding outcomes of palliative treatment. As only one-third of vascular resections showed confirmed macrovascular invasion, suspected vascular involvement should not be an absolute contraindication to resection. Nonetheless, caution is adviced when hepaticojejunostomy is required. Further studies are needed to assess outcomes following neoadjuvant therapy.
