Surgical treatment of cholangiocellular carcinoma

Intrahepatic cholangiocellular carcinoma (CCC) is known to be associated with severe symptoms and a particularly poor prognosis. Nonsurgical methods have failed to change this situation up to now. Surgical therapy, so far, is the only chance for effective treatment, but it has had limited success. The relative infrequency of this tumor does not allow extensive statistics and limits our present knowledge. In this contribution the outcome of 50 patients who underwent liver resection or liver transplantation in our institution is reported. Their courses have been reevaluated according to pathohistologic classification and TNM tumor staging. The median survival rates were 12.8 months in the group of patients after liver resection (n = 32) and 5.0 months after liver transplantation (n = 18). Liver transplantation, however, was performed only in patients with unresectable tumors. The longest survival after transplantation was 25 months; after resection four patients survived more than 5 years. In the resection group and the transplantation group survival rates correlated with tumor size and tumor stages according to TNM, although the differences were not statistically significant. Liver resection thus has its place in resectable situations. Liver transplantation for unresectable lesions of this tumor type--always deemed critically in the past--seems not to be indicated with our present stage of knowledge, unless adjuvant protocols appear promising and are tested.