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  3. Metastatic Lymph Node Burden And Invasive Tumour Features Inform First Recurrence Patterns After Curative-intent Resection For Intrahepatic Cholangiocarcinoma.
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Metastatic Lymph Node Burden And Invasive Tumour Features Inform First Recurrence Patterns After Curative-intent Resection For Intrahepatic Cholangiocarcinoma.

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Metastatic Lymph Node Burden and Invasive Tumour Features Inform First Recurrence Patterns After Curative-Intent

Kizuki Yuza1,2, Odysseas P Chatzipanagiotou1, Christian Hobeika3

  • 1Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.

The British Journal of Surgery
|June 16, 2026

View abstract on PubMed

Summary
This summary is machine-generated.

Postoperative pathology after intrahepatic cholangiocarcinoma (iCCA) resection predicts recurrence patterns. Combined recurrence, linked to nodal burden and microvascular invasion, worsens survival and limits treatment options.

Keywords:
intrahepatic cholangiocarcinomalymph node metastasismicrovascular invasionperineural invasionpost-recurrence survivalrecurrence pattern

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Area of Science:

  • Hepatobiliary surgery
  • Surgical oncology
  • Gastroenterology

Background:

  • Recurrence significantly impacts outcomes for intrahepatic cholangiocarcinoma (iCCA) patients undergoing curative-intent resection.
  • Understanding the relationship between postoperative pathology, recurrence patterns, and survival is crucial for improving patient management.

Purpose of the Study:

  • To investigate the association between postoperative pathological features and first recurrence patterns in iCCA.
  • To determine the impact of different recurrence patterns on post-recurrence survival (PRS) and the likelihood of receiving curative-intent treatment.

Main Methods:

  • Analysis of data from an international multi-institutional database of patients who had curative-intent resection for iCCA (2000-2023).
  • Classification of first recurrence patterns into intrahepatic-only, extrahepatic-only, or combined intrahepatic and extrahepatic.
  • Multivariable analyses to assess associations between pathological features, recurrence patterns, PRS, and post-recurrence treatment.

Main Results:

  • Of 1,328 patients, 57.5% recurred. Three or more metastatic lymph nodes and microvascular invasion were linked to combined recurrence.
  • Perineural invasion and lack of pathologic nodal evaluation were associated with extrahepatic-only recurrence.
  • Combined recurrence correlated with worse PRS and reduced odds of curative-intent treatment compared to intrahepatic-only recurrence.

Conclusions:

  • Postoperative pathological factors, including nodal burden and tumor invasion, predict distinct recurrence patterns after iCCA resection.
  • Combined recurrence, associated with adverse pathological findings, portends poorer survival and fewer treatment opportunities.
  • Pathological prognostic factors may guide risk-adapted surveillance strategies for iCCA patients post-resection.