title: Is Surgical Resection Justified for Advanced Intrahepatic Cholangiocarcinoma?
abstract: BACKGROUND
  Prognosis for patients with advanced intrahepatic cholangiocarcinoma (ICC) with intrahepatic metastasis (IM), vascular invasion (VI), or regional lymph node metastasis (LM) remains poor. The aim of this study was to clarify the indications for surgical resection for advanced ICC.
  
  
  METHODS
  We retrospectively divided 213 ICC patients treated at Kyoto University Hospital between 1993 and 2013 into a resection (n=164) group and a non-resection (n=49) group. Overall survival was assessed after stratification for the presence of IM, VI, or LM.
  
  
  RESULTS
  Overall median survival times (MSTs) for the resection and non-resection groups were 26.0 and 7.1 months, respectively (p<0.001). After stratification, MSTs in the resection and non-resection groups, respectively, were 18.7 vs. 7.0 months for patients with IM (p<0.001), 23.4 vs. 5.7 months for those with VI (p<0.001), and 12.8 vs. 5.5 months for those with LM (p<0.001).
  
  
  CONCLUSIONS
  When macroscopic curative resection is possible, surgical resection can be justified for some advanced ICC patients with IM, VI, or LM.
authors: Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors: Tomoaki
authors: T
authors: Yoh
authors: Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors: Etsuro
authors: E
authors: Hatano
authors: Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors: Kenya
authors: K
authors: Yamanaka
authors: Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors: Takahiro
authors: T
authors: Nishio
authors: Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors: Satoru
authors: S
authors: Seo
authors: Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors: Kojiro
authors: K
authors: Taura
authors: Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors: Kentaro
authors: K
authors: Yasuchika
authors: Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors: Hideaki
authors: H
authors: Okajima
authors: Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors: Toshimi
authors: T
authors: Kaido
authors: Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors: Shinji
authors: S
authors: Uemoto
keywords: Intrahepatic cholangiocarcinoma; Intrahepatic metastasis; Lymph node metastasis; Surgical resection; Vascular invasion