title: Surgical treatment for intrahepatic cholangiocarcinoma in Europe: a single center experience.
abstract: Intrahepatic cholangiocarcinoma is the second most common primary liver tumor. The aim of this study was to analyze retrospectively the outcome of surgical treatment and prognostic factors. Clinical, histopathological and treatment data of 221 patients treated from 1995 to 2010 at our institution were investigated. Univariate and multivariate analysis of the patient's data was performed. Patients after R0 and R1 resection presented an overall survival of 67% and 54.5% after 1 year and 40% and 36.4% after 3 years, respectively. The survival of patients without resection of the tumor was dismal with 26% and 3.4% after 1 and 3 years, respectively. Survival after resection was not statistically different in cases with R0 versus R1 resection (P = 0.639, log rank). Univariate Cox regression revealed that higher T stages are a significant hazard for survival (P = 0.048, hazard ratio (HR): 1.211, 95% confidence interval (CI): 1.002-2.465). Patients with tumor recurrence had a significantly inferior long-term survival when compared to patients without recurrence (P < 0.001, log rank). Presence of lymph node metastasis (N1) was an independent prognostic factor for survival after resection in risk-adjusted multivariate Cox regression (P < 0.001, HR: 2.577, 95% CI: 1.742-3.813). Adjuvant chemotherapy did not improve patient survival significantly (P = 0.550, log rank). Surgical resection is still the best treatment option for intrahepatic cholangiocarcinoma regarding the patient's long-term survival. R0 and R1 resection enable both better survival rates when compared to surgical exploration without resection. T status, N status, and tumor recurrence seem to be the most important prognostic factors after resection.
authors.affiliation: General, Visceral and Transplant Surgery, Hanover Medical School, Carl-Neuberg-Str. 1, D-30625, Hannover, Germany. bektas.hueseyin@mh-hannover.de.
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Bektas
authors.forename: Cemil
authors.initials: C
authors.lastname: Yeyrek
authors.forename: Moritz
authors.initials: M
authors.lastname: Kleine
authors.forename: Florian W R
authors.initials: FW
authors.lastname: Vondran
authors.forename: Kai
authors.initials: K
authors.lastname: Timrott
authors.forename: Nora
authors.initials: N
authors.lastname: Schweitzer
authors.forename: Arndt
authors.initials: A
authors.lastname: Vogel
authors.forename: Mark D
authors.initials: MD
authors.lastname: Jäger
authors.forename: Harald
authors.initials: H
authors.lastname: Schrem
authors.forename: Jürgen
authors.initials: J
authors.lastname: Klempnauer
authors.forename: Lampros
authors.initials: L
authors.lastname: Kousoulas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000453:epidemiology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006498:Hepatectomy / Q000379:methods* / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
keywords: Intrahepatic cholangiocarcinoma; Prognostic factors; Surgical treatment