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Published on: January 17, 2025
Is R1 Extended Liver Resection for Locally Advanced Intrahepatic Cholangiocarcinoma Justified? Nodal Status Not
Edoardo Maria Muttillo1, Daniel Cherqui2, Marc-Anthony Chouillard1
1Henri-Bismuth Hepatobiliary Center, Paul-Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Villejuif, France.
Annals of Surgical Oncology
|June 29, 2026
Summary
Aggressive surgery for locally advanced intrahepatic cholangiocarcinoma (LAICC) shows promising outcomes. Despite high morbidity, extended liver resections offer significant survival benefits, with R1 resection not contraindicating surgery.
Area of Science:
- Hepatobiliary surgery
- Surgical oncology
- Gastroenterology
Background:
- Locally advanced intrahepatic cholangiocarcinoma (LAICC) necessitates complex liver resections.
- The efficacy of high-risk LAICC surgery remains a subject of debate.
Purpose of the Study:
- To evaluate short-term and long-term outcomes of LAICC surgery.
- To assess surgical futility in LAICC patients.
Main Methods:
- Retrospective single-center study (2013-2024).
- Defined LAICC by tumor size, location, and need for extended resection (≥5 segments).
- Futility defined by 90-day mortality or 6-month recurrence.
Main Results:
- 39 patients underwent major hepatectomy, often requiring vascular/biliary reconstruction.
- Morbidity was 56% (severe 20%), with 5% 90-day mortality.
- Median overall survival: 58 months; recurrence-free survival: 23 months. Futility rate: 15.4%.
- Positive lymph nodes (N+) significantly impacted survival (p<0.05); R1 resection did not.
Conclusions:
- An aggressive surgical strategy is supported for LAICC.
- Anticipated R1 resection should not deter surgical intervention.
