title: Surgical treatment of intrahepatic cholangiocarcinoma: outcomes and predictive factors.
abstract: BACKGROUND
  Intrahepatic cholangiocarcinoma (ICC) remains a rare tumour, although its incidence is increasing. Surgical resection is the mainstay of treatment. Published data regarding prognostic factors and optimal patient selection for resection are scant. We sought to determine the clinicopathologic characteristics of resectable ICC and outcomes following surgical treatment.
  
  
  METHODS
  We reviewed prospectively collected clinical data including patient, pathologic and operative details. Survival and recurrence outcomes were analysed using Cox hazard models and the Kaplan-Meier method.
  
  
  RESULTS
  We identified 31 surgically treated patients. Their 3-year overall survival rate (OS) was 40.1%; median follow-up was 16.2 months (range: 0.2-86.9 months). R0 resection was associated with significantly improved OS compared with R1/R2 resection (3-year OS was 68.6% in R0 vs. 24.0% in R1/R2; P= 0.042). The postoperative complication rate was 58.1%. Two patients died of postoperative liver failure within 30 days. Preoperative hypoalbuminaemia was significantly associated with worse survival.
  
  
  CONCLUSIONS
  Surgical therapy for ICC is associated with longterm survival in the subset of nutritionally replete patients in whom an R0 resection can be achieved. Surgical mortality is significant in patients undergoing extended resection. The margin involvement rate is high and surgeons should consider the infiltrative nature of the disease in operative planning.
authors.affiliation: Division of Surgical Oncology, Oregon Health and Science University, Portland, OR 97239, USA.
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Ellis
authors.forename: Maria A
authors.initials: MA
authors.lastname: Cassera
authors.forename: John T
authors.initials: JT
authors.lastname: Vetto
authors.forename: Susan L
authors.initials: SL
authors.lastname: Orloff
authors.forename: Paul D
authors.initials: PD
authors.lastname: Hansen
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Billingsley
mesh_terms: D001118:Argentina / Q000453:epidemiology; D001650:Bile Duct Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome