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Outcomes After Resection for Multiple Intrahepatic Cholangiocarcinoma-A National Population-Based Study.

Hannes Jansson1, Helena Taflin2,3, Bergthor Björnsson4,5

  • 1Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. hannes.jansson@ki.se.

Annals of Surgical Oncology
|January 6, 2026
PubMed
Summary

Surgical resection for intrahepatic cholangiocarcinoma (iCCA) with multiple tumors is unclear. Resection for two or three iCCA lesions improved survival, but not for four or more.

Keywords:
Biliary tract cancerIntrahepatic cholangiocarcinomaLiver resectionPrognosisResection

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Area of Science:

  • Hepatobiliary surgery
  • Surgical oncology
  • Gastroenterology

Background:

  • Tumor multiplicity is a negative prognostic factor in intrahepatic cholangiocarcinoma (iCCA).
  • The role of surgical resection in multiple iCCA is not well-defined.
  • Understanding outcomes for multiple iCCA is crucial for treatment planning.

Purpose of the Study:

  • To evaluate the impact of surgical resection on overall survival (OS) in patients with multiple intrahepatic cholangiocarcinoma (iCCA).
  • To compare outcomes of surgical resection versus non-surgical therapy for multiple iCCA.
  • To identify factors influencing survival in patients with resectable multiple iCCA.

Main Methods:

  • Data from the Swedish quality registry for cancers of the liver and biliary tract (2010-2021) were analyzed.
  • Included patients undergoing surgery for iCCA, with a comparison cohort of non-surgical patients.
  • Overall survival (OS) was the primary endpoint, with validation across Swedish hepatobiliary centers.

Main Results:

  • Of 338 surgically treated patients, 16.2% had multiple lesions in the resection group and 20.4% in the unresectable group.
  • Patients with 2-3 multiple iCCA lesions undergoing resection had a median OS of 27.1 months vs. 5.3 months for unresectable disease (P < 0.001).
  • Resection for four or more iCCA lesions showed no survival benefit compared to unresectable disease (P = 0.922).

Conclusions:

  • Surgical resection for intrahepatic cholangiocarcinoma (iCCA) with four or more lesions did not improve survival compared to non-surgical management.
  • Resection of 2-3 iCCA lesions, in selected patients with good performance status, smaller tumors, and no lymph node metastasis, resulted in a median OS exceeding 2 years.