title: Aggressive surgical resection for hilar-invasive and peripheral intrahepatic cholangiocarcinoma.
abstract: The clinicopathology and surgical outcome of intrahepatic cholangiocarcinomas are not fully understood. The objective of this study was to clarify the clinicopathologic features of intrahepatic cholangiocarcinoma and evaluate prognostic factors influencing survival. Forty consecutive patients with intrahepatic cholangiocarcinomas undergoing surgical resection at Chiba University Hospital between October 1981 and October 1997 were analyzed retrospectively. Intrahepatic cholangiocarcinomas were classified as hilar-invasive type ( n = 26) or peripheral type ( n = 14). Patients with peripheral-type tumors had a significantly ( p = 0.005) better 5-year survival rate (43%) than those with the hilar-invasive type (4%). Hilar-invasive-type tumors had perineural invasion (100%) and nodal involvement (85%) more frequently than did peripheral-type tumors. Despite aggressive surgical resection, the surgical margin was positive in 88% of patients with hilar-invasive type tumors (23/26) and 29% of patients with peripheral-type tumors (4/14). There was no evidence of a survival benefit of vascular resection for patients with a hilar-invasive intrahepatic cholangiocarcinoma. Patients with lymph node metastasis had a significantly worse prognosis ( p = 0.0004). No patients with nodal involvement survived more than 38 months. Negative perineural invasion ( p = 0.008) and a negative microscopic margin ( p = 0.008) were significantly associated with improved survival. Better survival results could be achieved by curative resection with a free margin for hilar-invasive and peripheral intrahepatic cholangiocarcinoma.
authors.affiliation: Second Department of Surgery, Chiba University School of Medicine, 1-8-1 Inohana, 260-8670, Chuo-ku, Chiba, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Nakagohri
authors.forename: Takehide
authors.initials: T
authors.lastname: Asano
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Kinoshita
authors.forename: Takashi
authors.initials: T
authors.lastname: Kenmochi
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Urashima
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Miura
authors.forename: Takenori
authors.initials: T
authors.lastname: Ochiai
mesh_terms: D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011379:Prognosis; D012189:Retrospective Studies