title: Extended hepatectomy for intrahepatic cholangiocellular carcinoma (ICC): when is it worthwhile? Single center experience with 27 resections in 50 patients over a 5-year period.
abstract: OBJECTIVE
  To evaluate the role of extended hepatectomy in locally advanced intrahepatic cholangiocarcinoma (ICC).
  
  
  BACKGROUND
  ICC is a rare tumor which has to be clearly distinguished from hepatocellular carcinoma and extrahepatic bile duct carcinoma. It is believed that long-term survival can only be achieved by surgical resection.
  
  
  METHODS
  Between April 1998 and March 2003, 50 patients with locally advanced ICC (tumor involvement of more than 4 liver segments) underwent surgical exploration. Data were analyzed with regard to patients' characteristics, intraoperative details, pathologic findings, and outcome measured by tumor recurrence, treatment of recurrence, and survival.
  
  
  RESULTS
  Resectability rate was 27 of 50 (54%). There were 19 extended right and 8 extended left hepatectomies. In addition, in 16 patients the following 29 procedures were performed: resection of hilar bifurcation (n = 12), partial resection of diaphragm (n = 6), partial resection of vena cava (n = 4), resection and reinsertion of left liver vein (n = 1), portal vein resection (n = 5), resection and reconstruction of right hepatic artery (n = 1). Complete tumor removal (R0-resection) was achieved in 16 patients. In 11 cases, there was microscopic tumor at the cutting margin (R1-resection). Following resection, the overall 1- and 3-year-survival rates were 69% and 55%. After R1-resection and explorative laparotomy, median survival was 5 and 7 months, respectively. Following R0-resection, the calculated median survival and 1- and 3-year-survival rates are 46 months, 94% and 82% (P = 0.0039; log-rank test). Tumor recurred in 6 of 16 patients, and so far 2 patients died of recurrence 28 and 46 months after operation.
  
  
  CONCLUSIONS
  R0-resection can provide prolonged survival, even in patients with advanced ICC. In particular in solitary tumors without vascular invasion (UICC stage I, sixth classification) there is a major chance for long-term survival and cure. The poor results after R1-resection and the high operative morbidity do not justify palliative resections but underline the need for an improved preoperative assessment of resectability, as well as an aggressive intraoperative approach, to achieve complete tumor resection.
authors.affiliation: Department of General Surgery and Transplantation, University Hospital Essen, Hufelandstr. 55, D-45122 Essen, Germany. hauke.lang@uni-essen.de
authors.forename: Hauke
authors.initials: H
authors.lastname: Lang
authors.forename: Georgios C
authors.initials: GC
authors.lastname: Sotiropoulos
authors.forename: Nils R
authors.initials: NR
authors.lastname: Frühauf
authors.forename: Marco
authors.initials: M
authors.lastname: Dömland
authors.forename: Andreas
authors.initials: A
authors.lastname: Paul
authors.forename: Eva-Maria
authors.initials: EM
authors.lastname: Kind
authors.forename: Massimo
authors.initials: M
authors.lastname: Malagó
authors.forename: Christoph E
authors.initials: CE
authors.lastname: Broelsch
mesh_terms: D000328:Adult; D000368:Aged; D018281:Cholangiocarcinoma / Q000473:pathology / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D013514:Surgical Procedures, Operative / Q000379:methods; D016019:Survival Analysis; D016896:Treatment Outcome