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Intrahepatic cholangiocarcinoma. Results of aggressive surgical management
1Department of Digestive Surgery, Hôpital Henri Mondor-Université Paris XII, Créteil, France.
Objective:
To report the results of a deliberately aggressive surgical management in patients with intrahepatic cholangiocarcinoma.
Design:
A case series of patients with intrahepatic cholangiocarcinoma.
Setting:
A tertiary care university hospital in a metropolitan area.
Patients:
From 1989 to 1993, 19 patients with intrahepatic cholangiocarcinoma underwent laparotomy, with a 74% resectability rate (14 liver resections). In addition, two selected patients with a slow-growing tumor underwent orthotopic liver transplantation after limited recurrence following resection in one case and after exploratory laparotomy in the other.
Interventions:
The 14 liver resections included six right or left hepatectomies and eight extended right or left hepatectomies. Total vascular exclusion of the liver was used in nine cases (64%) and resection of the biliary confluence with reconstruction was used in six cases (43%).
Results:
There was one postoperative death (7%). There were four postoperative biliary fistulas (28%). Overall actuarial 1- and 2-year survival rates were 58% and 32%, respectively. The 1- and 2-year survival rates were 100% after curative resection (no lymph node invasion, clearance margin of < or = 1 cm, and solitary tumor [five cases]) and 48% and 10% after palliative resection. Median survival was 14 months for the whole series and 27 and 9 months following curative and palliative resections, respectively. The two liver transplant recipients are alive and free of disease at 25 and 31 months.
Conclusion:
These results support aggressive surgical management in patients with intrahepatic cholangiocarcinoma, including complex liver resection procedures and selective use of orthotopic liver transplantation.