title: Surgical treatment of intrahepatic cholangiocarcinoma: four patients surviving more than five years.
abstract: BACKGROUND
  To find the rational surgical strategy for the treatment of intrahepatic cholangiocarcinoma (ICC), clinical features of ICC were studied in 20 patients who underwent hepatic resection in the National Cancer Center Hospital from 1980 to 1990.
  
  
  METHODS
  According to the morphologic pattern, we classified the ICCs into two subcategories, mass-forming and infiltrating, which correlated with their biologic behavior.
  
  
  RESULTS
  Of 10 patients who underwent hepatectomy for mass-forming ICC, three survived more than 5 years without recurrence. The 1-, 3-, and 5-year survival rates were 59.3%, 44.4%, and 44.4%, respectively. Of 10 patients who underwent hepatectomy for infiltrating ICC, one survived more than 5 years without recurrence. The 1-, 3-, and 5-year survival rates were 72.0%, 27.0%, and 27.0%, respectively. The pathologic findings and recurrences indicated that the salient feature of the mass-forming type was its tendency for intrahepatic metastasis especially near a main lesion, and of the infiltrating type was the infiltrative spread via Glisson's capsule and hilar lymph nodal metastasis.
  
  
  CONCLUSIONS
  An anatomic and extensive liver resection should be performed for mass-forming ICC, whereas a hepatectomy with excision of the extrahepatic bile duct and hilar lymph nodal dissection is recommended for infiltrating ICC.
authors.affiliation: Department of Surgery, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: J
authors.initials: J
authors.lastname: Yamamoto
authors.forename: T
authors.initials: T
authors.lastname: Kosuge
authors.forename: T
authors.initials: T
authors.lastname: Takayama
authors.forename: K
authors.initials: K
authors.lastname: Shimada
authors.forename: M
authors.initials: M
authors.lastname: Makuuchi
authors.forename: J
authors.initials: J
authors.lastname: Yoshida
authors.forename: M
authors.initials: M
authors.lastname: Sakamoto
authors.forename: S
authors.initials: S
authors.lastname: Hirohashi
authors.forename: S
authors.initials: S
authors.lastname: Yamasaki
authors.forename: H
authors.initials: H
authors.lastname: Hasegawa
mesh_terms: D002759:Adenoma, Bile Duct / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D016019:Survival Analysis; D013997:Time Factors