title: Is Hepatic Resection for Large or Multifocal Intrahepatic Cholangiocarcinoma Justified? Results from a Multi-Institutional Collaboration.
abstract: BACKGROUND
  The role of surgical resection for patients with large or multifocal intrahepatic cholangiocarcinoma (ICC) remains unclear. This study evaluated the long-term outcome of patients who underwent hepatic resection for large (≥7 cm) or multifocal (≥2) ICC.
  
  
  METHODS
  Between 1990 and 2013, 557 patients who underwent liver resection for ICC were identified from a multi-institutional database. Clinicopathologic characteristics, operative details, and long-term survival data were evaluated.
  
  
  RESULTS
  Of the 557 patients, 215 (38.6 %) had a small, solitary ICC (group A) and 342 (61.4 %) had a large or multifocal ICC (group B). The patients in group B underwent an extended hepatectomy more frequently (16.9 vs. 30.4 %; P < 0.001). At the final pathology exam, the patients in group B were more likely to show evidence of vascular invasion (22.5 vs. 38.5 %), direct invasion of contiguous organs (6.5 vs. 12.9 %), and nodal metastasis (13.3 vs. 21.0 %) (all P < 0.05). Interestingly, the incidences of postoperative complications (39.3 vs. 46.8 %) and hospital mortality (1.1 vs. 3.7 %) were similar between the two groups (both P > 0.05). The group A patients had better rates for 5-year overall survival (OS) (30.5 vs. 18.7 %; P < 0.05) and disease-free survival (DFS) (22.6 vs. 8.2 %; P < 0.05) than the group B patients. For the patients in group B, the factors associated with a worse OS included more than three tumor nodules [hazard ratio (HR), 1.56], nodal metastasis (HR, 1.47), and poor differentiation (HR, 1.48).
  
  
  CONCLUSIONS
  Liver resection can be performed safely for patients with large or multifocal ICC. The long-term outcome for these patients can be stratified on the basis of a prognostic score that includes tumor number, nodal metastasis, and poor differentiation.
authors.affiliation: The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Gaya
authors.initials: G
authors.lastname: Spolverato
authors.forename: Yuhree
authors.initials: Y
authors.lastname: Kim
authors.forename: Sorin
authors.initials: S
authors.lastname: Alexandrescu
authors.forename: Irinel
authors.initials: I
authors.lastname: Popescu
authors.forename: Hugo P
authors.initials: HP
authors.lastname: Marques
authors.forename: Luca
authors.initials: L
authors.lastname: Aldrighetti
authors.forename: T
authors.initials: T
authors.lastname: Clark Gamblin
authors.forename: John
authors.initials: J
authors.lastname: Miura
authors.forename: Shishir K
authors.initials: SK
authors.lastname: Maithel
authors.forename: Malcolm H
authors.initials: MH
authors.lastname: Squires
authors.forename: Carlo
authors.initials: C
authors.lastname: Pulitano
authors.forename: Charbel
authors.initials: C
authors.lastname: Sandroussi
authors.forename: Gilles
authors.initials: G
authors.lastname: Mentha
authors.forename: Todd W
authors.initials: TW
authors.lastname: Bauer
authors.forename: Timothy
authors.initials: T
authors.lastname: Newhook
authors.forename: Feng
authors.initials: F
authors.lastname: Shen
authors.forename: George A
authors.initials: GA
authors.lastname: Poultsides
authors.forename: J
authors.initials: J
authors.lastname: Wallis Marsh
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D015996:Survival Rate