title: Role of major vascular resection in patients with intrahepatic cholangiocarcinoma.
abstract: BACKGROUND
  Historically, direct vascular extension of intrahepatic cholangiocarcinoma (ICC) has often been considered a contraindication to resection. However, recent studies have suggested safety and efficacy of hepatectomy with major vascular resection in this patient population. The aim of this study was to investigate the short and long-term clinical outcomes of patients with ICC treated with hepatectomy with or without major vascular resection.
  
  
  METHODS
  This retrospective cohort study included all patients with ICC who underwent major liver resection between 1997 and 2011. Clinical outcomes were compared between patients treated with major hepatectomy and vascular resection (VR) and those without vascular resection (NVR). Kaplan-Meier survival estimates were used to compare overall survival (OS) between patients in VR and NVR groups.
  
  
  RESULTS
  A total of 121 patients (median age 60; 42 % male) underwent major hepatectomy for ICC. Major vascular resection was performed in 14 (12 %) patients (IVC = 9, PV = 5). Age, sex, American Society of Anesthesiology (ASA) class, tumor size, lymph node status, and CA-19 9 were comparable (all p ≥ 0.184) between VR and NVR groups. Major postoperative complications (Dindo-Clavien ≥3) occurred in four (29 %) patients in the VR group and 17 (16 %) in the NVR group (p = 0.263). Postoperative death occurred in one patient in the VR group due to liver failure. Median OS did not differ between patients treated with and without vascular resection (32 vs. 49 months, respectively, p = 0.268).
  
  
  CONCLUSIONS
  Hepatectomy combined with IVC or PV resection can be safely performed in patients with ICC. Major vascular resection does not affect short and long-term outcomes in this patient population.
authors.affiliation: Division of Gastroenterologic and General Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Shahzad M
authors.initials: SM
authors.lastname: Ali
authors.forename: Clancy J
authors.initials: CJ
authors.lastname: Clark
authors.forename: Victor M
authors.initials: VM
authors.lastname: Zaydfudim
authors.forename: Florencia G
authors.initials: FG
authors.lastname: Que
authors.forename: David M
authors.initials: DM
authors.lastname: Nagorney
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000473:pathology* / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D018281:Cholangiocarcinoma / Q000556:secondary / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects; D006503:Hepatic Veins / Q000473:pathology / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011169:Portal Vein / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D014682:Vena Cava, Inferior / Q000473:pathology / Q000601:surgery*