Clinicopathologic features in patients with long-term survival following resection for intrahepatic cholangiocarcinoma

BACKGROUND/AIMS: As the overall prognosis for patients with intrahepatic cholangiocarcinoma is extremely poor, it is important to identify specific clinicopathologic features associated with long-term survival after hepatic resection for this tumor. METHODOLOGY: Of 54 patients who underwent hepatic resection for intrahepatic cholangiocarcinoma, 9 survived more than 5 years after surgery (survival group), while 28 patients died of recurrence within 3 years of surgery (early recurrence group). Clinicopathologic features were compared retrospectively between groups. RESULTS: Although clinical features in patients with long-term survival were similar to those in patients with early recurrence, lymphatic invasion, lymph node metastasis, intrahepatic metastasis and tumor involving the resection margin were more frequent in patients with early recurrence. CONCLUSIONS: Hepatic resection for intrahepatic cholangiocarcinoma without lymph node metastasis or intrahepatic metastasis offers hope for long-term survival.     

Analysis of the prognostic factors for liver metastasis of gastric cancer after hepatic resection: a multi-institutional study of the indications for resection

BACKGROUND/AIMS: The number of reports of hepatic resection for metastatic gastric cancer is very small. The outcome and indications of hepatic resection for metastatic gastric cancer remains unknown. METHODOLOGY: A multi-institutional study was made. Thirty-six patients who underwent a hepatic resection for liver metastasis of gastric cancer with no residual tumor were included in this study. The clinicopathological factors were examined as prognostic factors by multivariate analyses. Thirty patients had recurrence and the recurrence pattern and risk factors for extrahepatic recurrence was examined. RESULTS: The overall survival rate was 64% at 1 year, 43% at 2 years, 26% at 3 years 26% at 5 years, and 26% at 10 years after hepatectomy. Multivariate analysis showed that lymphatic invasion, venous invasion of cancer cells of primary gastric cancer and the number of the liver metastasis (> 3) were independent poor prognostic factors after hepatic resection. The most common recurrence pattern was intrahepatic recurrence in 22 patients (73%). The risk factors for extrahepatic recurrence was serosal invasion, lymph node metastasis of primary gastric cancer, stage, and curability of operation. CONCLUSIONS: Hepatic resection for liver metastasis should be attempted in case primary gastric cancer has neither lymphatic invasion nor venous invasion. The most common recurrent site was the liver. In patients with advanced gastric cancer, having neither serosal invasion nor lymph node metastasis, who underwent a less curative operation, the intra-hepatic recurrence would be expected. Thus, aggressive adjuvant chemotherapy through the hepatic artery may improve the survival after hepatectomy in these patients.     

Serosal invasion in TNM staging of mass-forming intrahepatic cholangiocarcinoma

Background/Purpose

The Liver Cancer Study Group of Japan established a tumor-nodule-metastasis (TNM) staging system for mass-forming intrahepatic cholangiocarcinoma, with T determined by tumor number and size and vascular or serosal invasion. Serosal invasion is not considered in the designation established by the International Union Against Cancer.

Methods

Sixty-three patients who underwent hepatic resection for mass-forming intrahepatic cholangiocarcinoma were investigated retrospectively, with the investigation including univariate and multivariate analyses of potential prognostic factors.

Results

By log-rank test, tumor size more than 3.0?cm, vascular invasion, lymph node metastasis, intrahepatic metastasis, and involved resection margin, but not serosal invasion, were associated significantly with poor prognosis. Even in patients with serosal invasion, the postoperative outcome was much better in those without than in those with vascular invasion. Multivariate analysis identified vascular invasion, lymph node metastasis, and an involved resection margin as independent prognostic factors. When serosal invasion was excluded from tumor staging, the 5-year survival rates became more clearly stratified: 100% in those with stage I disease, 62% in those with stage II, 25% in those with stage III, and 7% for patients with stage IV.

Conclusions

Serosal invasion showed no survival impact after hepatic resection for mass-forming intrahepatic cholangiocarcinoma. When serosal invasion was omitted from the TNM staging proposed by the Liver Cancer Study Group of Japan, stratification of postoperative survival between stages was more effective.     

Long-term survival of intrahepatic cholangiocarcinoma with hilar lymph node metastasis and portal vein involvement

We report the case of a very rare 6-year disease-free survivor of intrahepatic cholangiocarcinoma with hilar lymph node metastasis and portal vein involvement. A 76-year-old female with liver dysfunction was referred to our institution. Contrast-enhanced computed tomography showed a 5-cm low-density tumor with irregular marginal enhancement in the left and caudate lobes of the liver. Cholangiography revealed complete obstruction of the left hepatic bile duct. Angiography showed obstruction of the left branch of the portal vein. Metastasis to the hilar lymph nodes was disclosed at surgery. The patient underwent left hepatectomy with caudate lobectomy, resection of the extrahepatic bile duct, and lymphadenectomy. The total vascular exclusion of the liver was used for hepatectomy and reconstruction of the portal vein. Microscopically, the tumor was a poorly differentiated adenocarcinoma with many infiltrating lymphocytes, and extensive necrosis was present within the tumor. The experience gained in the present case suggests that aggressive surgery may be a potential approach to provide a hope of long-term survival for patients with intrahepatic cholangiocarcinoma despite the presence of regional lymph node metastasis and vascular invasion.     

Hepatopancreatoduodenectomy could be allowed for patients with advanced intrahepatic cholangiocarcinoma

BACKGROUND/AIMS: Patients with advanced intrahepatic cholangiocarcinoma (ICC) have a poor outcome even if they undergo extended radical surgery. Hepatopancreatoduodenectomy (HPD; hepatectomy with pancreatoduodenectomy) for ICCs may be expected to provide a favorable outcome if curative resection is reasonable and patients can tolerate the radical major procedure. METHODOLOGY: Between January 1981 and March 2002, 152 hepatic resections were performed for ICC. Of these, 12 patients underwent HPD for ICC at the same institute of Gastroenterology, Tokyo Women's Medical University. HPD for ICC was indicated in patients who (1) require dissection of the peripancreatic lymph nodes, (2) exhibit direct invasion of intrapancreatic bile duct, (3) show signs of intrapancreatic bile ductal growth. RESULTS: Characteristics of the short-term survivors (died within 12 months), compared with long-term survivors (survived more than 12 months), indicated that they were more likely to be positive intrahepatic metastasis, to be positive lymph node metastasis, to be positive portal venous invasion, and margins of resected surface with residual tumor. The actuarial overall 1-, 3-, 5-, 10-year survival rates were 42%, 33%, 33%, and 23%, respectively. The 5-year survival rate in patients without lymph node metastasis was significantly better (p = 0.045) than that of patients with lymph node metastasis. The patients who underwent potentially curative resection had significantly better 5-year survival rates than those who underwent non-curative resection. Four patients survived for at least 5 years and two of these patients survived for more than 10 years. Nine patients developed recurrence after resection, and of these, 5 patients with recurrence died within 12 months after surgery. CONCLUSIONS: HPD is considered to be an efficacious procedure for advanced ICC and long-term survival may be possible in a selected group of patients.     

Hepatic resection for intrahepatic cholangiocarcinoma: relation to gross tumor morphology

BACKGROUND/AIMS: The aim of this study was to investigate the clinicopathologic features and biological behaviors related to the gross appearance of intrahepatic cholangiocarcinoma. METHODOLOGY: Fourteen patients with intrahepatic cholangiocarcinoma who underwent hepatic resection between 1986 and 1998 were divided into four groups according to the gross appearance of the tumor: ID (intraductal growth) type (n = 1), PD (periductal-infiltrating) type (n = 4), MF (mass-forming) type (n = 5), MF-with-PD type (n = 4). RESULTS: Overall survival at 1, 5, and 10 years was 50.0%, 35.7%, and 35.7%, respectively. All three long-term survivors without recurrence had tumors unassociated with vascular invasion, intrahepatic metastasis, or lymph node metastasis. The MF and MF-with-PD tumors were more frequently associated with vascular invasion and/or lymph node metastasis than the ID or PD type. The Ki-67-positive grade of the cancer cells was clearly higher in the MF and MF-with-PD tumors than in the ID or PD type. All of the cases of MF-with-PD tumors were stage IV-A and had a poor outcome. CONCLUSIONS: Extended hepatic resection with a sufficient surgical margin yielded good results in intrahepatic cholangiocarcinoma patients without vascular invasion, intrahepatic metastasis, or lymph node metastasis. However, it is necessary to develop a new effective strategy for advanced intrahepatic cholangiocarcinomas, such as the MF-with-PD type.     

Macroscopic types of intrahepatic cholangiocarcinoma: clinicopathologic features and surgical outcomes

BACKGROUND/AIMS: The prognosis of patients with intrahepatic cholangiocarcinoma is different for the different macroscopic types of this tumor. This study correlated clinicopathologic features and outcome after surgery with macroscopic types of intrahepatic cholangiocarcinoma to determine prognostic predictors. METHODOLOGY: Resected intrahepatic cholangiocarcinomas were classified into the following growth types: mass-forming (n = 10), periductal-infiltrating (n = 11), mass-forming plus periductal-infiltrating (n = 14), and intraductal (n = 2). Intraductal tumors were not considered further. The prognostic significance of clinicopathologic features was determined by univariate and multivariate analyses. RESULTS: Perineural invasion (P = 0.00051), lymphatic invasion (P = 0.0088), and positive resection margin (P = 0.028) were less frequent in patients with mass-forming tumors than with mass-forming plus periductal-infiltrating tumors. Patients with mass-forming plus periductal-infiltrating tumors had shorter survival than those with mass-forming tumors (P = 0.0072). By univariate analysis, an elevated serum carcinoembryonic antigen concentration, lymphatic invasion, lymph node metastasis, intrahepatic metastasis, and positive resection margin predicted shorter survival after surgery. An elevated serum carcinoembryonic antigen concentration, lymphatic invasion, and positive resection margin were independent prognostic factors on multivariate analysis. The macroscopic type did not correlate independently with prognosis. CONCLUSIONS: Extended hepatic resection should be performed in patients with intrahepatic cholangiocarcinoma to obtain a tumor-free margin of resection.     

The morbidity, mortality, and prognostic factors for ampullary carcinoma and distal cholangiocarcinoma

BACKGROUND/AIMS: Ampullary carcinoma and distal cholangiocarcinoma are potentially more amenable to pancreaticoduodenectomy for long-term survival than pancreatic carcinoma. The aims of this study are to evaluate experience with ampullary carcinoma and distal cholangiocarcinoma at a single institution. METHODOLOGY: Seventy-two consecutive patients with ampullary carcinoma and distal cholangiocarcinoma who underwent radical resection at Chiba University Hospital from 1985 to 2001. Clinicopathological factors for survival were evaluated by univariate and multivariate analyses in a retrospective study. RESULTS: Pancreaticoduodenectomy was performed in 37 of 38 patients for ampullary carcinoma and 29 of 34 patients for distal cholangiocarcinoma. The morbidity rates of patients with ampullary carcinoma and distal cholangiocarcinoma were 21.1% and 20.6%, and mortality rates were 0% and 2.9%, respectively. The cumulative 5-year survival rates in cases of ampullary carcinoma and distal cholangiocarcinoma were 63% and 45%, respectively. By univariate analysis, pancreatic invasion, lymph node metastasis, and duodenal invasion were significant prognostic factors for ampullary carcinoma. Perineural invasion and histological grade, but not lymph node metastasis, were significant factors for distal cholangiocarcinoma. Multivariate analysis indicated that lymph node metastasis was the only independent prognostic factor for ampullary carcinoma, and that perineural invasion was the only independent prognostic factor for distal cholangiocarcinoma. CONCLUSIONS: The overall mortality of 1.4% and the cumulative 5-year survival rates for ampullary carcinoma and distal cholangiocarcinoma are acceptable. Ampullary carcinoma with lymph node metastasis and distal cholangiocarcinoma with perineural invasion have higher risk of recurrence.     

Guidelines for the management of biliary tract and ampullary carcinomas: surgical treatment

The only curative treatment in biliary tract cancer is surgical treatment. Therefore, the suitability of curative resection should be investigated in the first place. In the presence of metastasis to the liver, lung, peritoneum, or distant lymph nodes, curative resection is not suitable. No definite consensus has been reached on local extension factors and curability. Measures of hepatic functional reserve in the jaundiced liver include future liver remnant volume and the indocyanine green (ICG) clearance test. Preoperative portal vein embolization may be considered in patients in whom right hepatectomy or more, or hepatectomy with a resection rate exceeding 50%–60% is planned. Postoperative complications and surgery-related mortality may be reduced with the use of portal vein embolization. Although hepatectomy and/or pancreaticoduodenectomy are preferable for the curative resection of bile duct cancer, extrahepatic bile duct resection alone is also considered in patients for whom it is judged that curative resection would be achieved after a strict diagnosis of its local extension. Also, combined caudate lobe resection is recommended for hilar cholangiocarcinoma. Because the prognosis of patients treated with combined portal vein resection is significantly better than that of unresected patients, combined portal vein resection may be carried out. Prognostic factors after resection for bile duct cancer include positive surgical margins, especially in the ductal stump; lymph node metastasis; perineural invasion; and combined vascular resection due to portal vein and/or hepatic artery invasion. For patients with suspected gallbladder cancer, laparoscopic cholecystectomy is not recommended, and open cholecystectomy should be performed as a rule. When gallbladder cancer invading the subserosal layer or deeper has been detected after simple cholecystectomy, additional resection should be considered. Prognostic factors after resection for gallbladder cancer include the depth of mural invasion; lymph node metastasis; extramural extension, especially into the hepatoduodenal ligament; perineural invasion; and the degree of curability. Pancreaticoduodenectomy is indicated for ampullary carcinoma, and limited operation is also indicated for carcinoma in adenoma. The prognostic factors after resection for ampullary carcinoma include lymph node metastasis, pancreatic invasion, and perineural invasion.     

Prognosis after resection for hepatitis B virus-associated intrahepatic cholangiocarcinoma

AIM:To investigate the prognostic factors after resection for hepatitis B virus(HBV)-associated intrahepatic cholangiocarcinoma(ICC) and to assess the impact of different extents of lymphadenectomy on patient survival.METHODS:A total of 85 patients with HBV-associated ICC who underwent curative resection from January 2005 to December 2006 were analyzed.The patients were classified into groups according to the extent of lymphadenectomy(no lymph node dissection,sampling lymph node dissection and regional lymph node dissection).Clinicopathological characteristics and survival were reviewed retrospectively.RESULTS:The cumulative 1-,3-,and 5-year survival rates were found to be 60 %,18 %,and 13 %,respectively.Multivariate analysis revealed that liver cirrhosis(HR = 1.875,95%CI:1.197-3.278,P = 0.008) and multiple tumors(HR = 2.653,95%CI:1.562-4.508,P 0.001) were independent prognostic factors for survival.Recurrence occurred in 70 patients.The 1-,3-,and 5-year disease-free survival rates were 36%,3% and 0%,respectively.Liver cirrhosis(HR = 1.919,P = 0.012),advanced TNM stage(stage Ⅲ/Ⅳ)(HR = 2.027,P 0.001),and vascular invasion(HR = 3.779,P = 0.02) were independent prognostic factors for disease-free survival.Patients with regional lymph node dissection demonstrated a similar survival rate to patients with sampling lymph node dissection.Lymphadenectomy did not significantly improve the survival rate of patients with negative lymph node status.CONCLUSION:The extent of lymphadenectomy does not seem to have influence on the survival of patients with HBV-associated ICC,and routine lymph nodedissection is not recommended,particularly for those without lymph node metastasis.     

Our experiences in surgical treatment for hilar cholangiocarcinoma

BACKGROUND/AIMS: Although resection for hilar cholangiocarcinoma usually requires difficult surgical manipulations, it is only one therapeutic modality for a permanent cure or a desirable prognosis. We verified our own experiences after surgical treatment for hilar cholangiocarcinoma. METHODOLOGY: This study included 24 patients with hilar cholangiocarcinoma from 1981 to 2002. The current study mainly evaluated postoperative complications and overall prognosis after resection. RESULTS: Twenty-one patients received tumor resection. Hepatic resection including extended hepatectomy was required in 19 patients (90.5%). Postoperative morbidity was observed in 16 (71.2%), and motality in 2 (9.5%). The overall 5-year survival rate was 33.7%, and median survival was 35.7 months. Tumor extent in the TNM stage (p = 0.011) and the existence of lymph node metastases (p = 0.038) were identified as significant prognostic factors in overall survival after operation by univariate analysis. Postoperative adjuvant radio-chemotherapy after resection improved their prognosis (p = 0.010). CONCLUSIONS: Our results suggest that aggressive resection and appropriate adjuvant therapies for hilar cholangiocarcinoma might make a better prognosis possible, especially in patients without lymph node metastases excluding advanced tumor.     

Factors influencing recurrence after surgical treatment for T2 gallbladder carcinoma

BACKGROUND/AIMS: The overall outcome of T2 gallbladder carcinoma has not been favorable, although there is a modest hope for long-term survival after radical resection. The aim of this study was to examine factors influencing postoperative disease-free survival of patients with T2 gallbladder carcinoma to clarify optimal treatment. METHODOLOGY: Of 53 patients with gallbladder carcinoma who had undergone surgical resection from 1985 to 2000, 22 had T2 carcinoma histologically proved. The significance of variables for disease-free survival was examined retrospectively by the Kaplan-Meier method and the log-rank test. RESULTS: There were 16 patients with stage II (T2N0M0), 6 with stage III (T2N1M0) disease. Eleven patients were treated by extended cholecystectomy with resection of the extrahepatic bile duct, 10 patients underwent extended cholecystectomy without resection of the extrahepatic bile duct, and 1 patient underwent cholecystectomy. All patients underwent lymph node dissection in the hepatoduodenal ligament, below the pancreatic head, and along the common hepatic artery. Lymph node metastasis was present in 6 patients. Lymphatic, venous, and perineural invasions were found in 9, 4, and 4 patients, respectively. The absence of lymphatic invasion was a significant factor related to good postoperative disease-free survival (5-year disease-free survival rate, 88.9% vs. 31.3% in the presence of lymphatic invasion). Lymph node, venous, or perineural invasion, and surgical procedure were not significant factors to good postoperative disease-free survival. CONCLUSIONS: For patients with T2 gallbladder carcinoma, the presence of lymphatic invasion is an unfavorable prognostic indicator that calls for additional treatment after radical surgery.     

Aggressive preoperative management and extended surgery for hilar cholangiocarcinoma: Nagoya experience

From 1977 to 1997, surgical resection was possible in 142 (80%) of 177 patients with hilar cholangiocarcinoma after relieving jaundice by single or multiple percutaneous transhepatic biliary drainage followed by percutaneous transhepatic cholangioscopy and/or percutaneous trans‐hepatic portal vein embolization. Curative resection was possible in 108 (61%) of the 142 patients, and 100 of these patients underwent various types of hepatectomy with caudate lobectomy for a 30‐day operative mortality rate of 6% and 9% hospital mortality. Combined portal vein resection was carried out in 43 cases including 41 hepatectomies and 2 bile duct resections. Hepatopancreatoduodenectomy was performed in 16 patients. Cancer recurrence was observed in 58 of the 108 patients undergoing curative resection. The 3‐, 5‐, and 10‐year survival rates for 100 patients undergoing curative hepatectomy and 8 with curative bile duct resection were 43%, 26%, and 19%; and 31%, 16%, and 0%, respectively; those for 40 patients with positive lymph node metastasis, 84 with perineural invasion, and 43 with combined portal vein resection were 27%, 14%, and 7%; 34%, 21%, and 13%; and 18%, 6%, and 0%, respectively. These survival rates are significantly better than those for 35 patients with unresectable cancer. Curative resection after aggressive preoperative management is recommended as a reasonable surgical approach to hilar cholangiocarcinoma.     

Postoperative survival in intrahepatic cholangiocarcinoma showing intraductal growth

Clinicopathologic variables favoring recurrence after hepatic resection for intrahepatic cholangiocarcinoma showing intraductal growth remain unclear. We investigated various clinicopathologic features in three patients who underwent resection for this type of intrahepatic cholangiocarcinoma. All underwent extended left hepatectomy plus resection of the caudate lobe and lymph node dissection. Lymph nodes showed no pathologic involvement. Although no cancer cells were seen in the mucosal layer by intraoperative pathologic examination at the bile duct stump in any patient, pathologic examination of resected specimens showed cancer cells invading beyond the mucosal layer in connective tissues surrounding the bile duct stump (interstitial invasion) of the Glisson's sheath in 2 patients. One of them died of cancer recurrence near the bile duct stump, while the third patient, without interstitial invasion, has survived for 10.6 years. In the intraductal growth type of intrahepatic cholangiocarcinoma, absence of cancer cells should be confirmed by intraoperative pathologic examination of not only the mucosal layer of the bile duct but also the connective tissue surrounding the bile duct, since interstitial invasion may be a risk factor for cancer recurrence.     

Patient outcome and prognostic factors in intrahepatic cholangiocarcinoma after hepatectomy

BACKGROUND/AIMS: The present study was designed to provide a systematic analysis of prognosis of patients who underwent hepatic resection for intrahepatic cholangiocarcinoma (ICC). METHODOLOGY: Subjects were 36 consecutive ICC patients who had undergone hepatic resection between 1994 and 2005. The analyzed factors included various clinicopathological and surgical parameters, counts of microvessel stained for CD34 and expression of proliferative cell nuclear antigen. RESULTS: The 1, 2, 3-year disease-free survival rates after surgery were 33, 18, and 0% and the 1, 3 and 5-year overall survival rates were 45, 29, and 8%. High CEA levels (> or = 10 ng/mL), excessive intraoperative blood loss (> or = 1000 mL) and presence of neighboring peritoneal dissemination were significantly associated with shorter disease-free survival (p < 0.05). High CEA levels, periductal invasion type, excessive intraoperative blood loss and non-fibrotic liver were significant factors associated with shorter overall survival (p < 0.05). Multivariate Cox proportional hazards regression model identified high CEA values, periductal invasive type, excessive intraoperative blood loss and non-fibrotic liver as significant and independent determinants of poor prognosis. CONCLUSIONS: Hepatic resection with minimal blood loss followed by close follow-up is a suitable strategy for management of ICC patients with poor prognostic factors.     

Predictive factors of recurrence for patients with intrahepatic cholangiocarcinoma after hepatectomy

Background/Aims: To identify risk factors related to postoperative recurrence for intrahepatic cholangiocarcinoma (ICC) patients with negative resection margin. Methodology: A total of 64 ICC patients who underwent resection with negative margin at our center from 2002 to 2010 were recruited in the present study. All clinicopathological characteristics were assessed using univariate analyses. Independent risk factors were identified by Cox regression. Factors significant at a p<0.10 in the univariate analyses were involved in the multivariate analyses. The diagnostic accuracy of the identified risk factors was evaluated using receiver operating curve (ROC). Results: The overall 1-, 3- and 5-year recurrence-free survival rates for patients with ICC were 63%, 32% and 27%, respectively. The most common site of postoperative recurrence was the liver. Lymph node metastasis, perineural invasion and total tumor size greater than 5cm showed prognostic power in multivariate analysis. The recurrence-free survival rates reduced with the increasing of the number of risk factor for patients with ICC. Conclusions: This study suggested liver was the most common recurrence site and confirmed lymph node metastasis, perineural invasion and total tumor size greater than 5cm may be associated with poor outcome for ICC patients with negative resection margin.     

Intrahepatic cholangiocarcinoma in Hong Kong

We retrospectively analyzed the results of hepatic resection for patients with intrahepatic cholangiocarcinoma managed between December 1966 and January 1998 at the University of Hong Kong Medical Center, Queen Mary Hospital. There were 61 men and 40 women (mean age, 61.8 years). The clinical records of these patients were reviewed. A survival analysis was performed on the group of patients who had undergone hepatic resection. Twenty-one patients were treated conservatively. Non-resective (palliative) operations were performed in 32 patients. The median survivals after conservative management and palliative operation were 2.5 and 3.3 months, respectively. The remaining 48 patients underwent hepatic resection. The overall operative morbidity and mortality rates after hepatic resection were 41.7% and 16.7%, respectively. The median survival after hepatic resection was 16.4 months. The overall 1-, 3-, and 5-year survival rates after hepatic resection were 60.3%, 29.4% and 22.0%, respectively. Lymphatic permeation (P = 0.007) and hilar nodal metastases (P = 0.009) were found to be significantly associated with poor survival after hepatic resection. Hepatic resection is the treatment of choice for intrahepatic cholangiocarcinoma when it is resectable.     

Step classification is useful for the determination of indications for systematized hepatectomy in hepatocellular carcinoma

Background/Purpose

The effectiveness of systematized hepatectomy with transection of Glisson's pedicle at the hepatic hilus has not been clarified in detail in relation to previous staging systems. Outcomes after systematized hepatectomy in patients with hepatocellular carcinoma (HCC) were examined in relation to our new staging system.

Methods

We retrospectively studied 955 patients with HCC who underwent hepatectomy from 1989 through 2002. We classified patients with HCC into four groups according to the pathological findings (pathological step [p-step]): p-step 1, HCC with absence of vascular invasion and absence of intrahepatic metastasis; p-step 2, HCC with vascular invasion and/or intrahepatic metastasis; p-step 3, HCC with major vascular invasion and/or intrahepatic metastasis to both lobes of the liver; and p-step 4, HCC with distant metastasis, including lymph node metastasis or ruptured HCC). We separated the liver into three segments (Takasaki's liver segments). Systematized hepatectomy was classified as systematized segmentectomy or larger resection, and partial segmentectomy. Segmentectomy refers to resection of one of Takasaki's segments.

Results

Systematized segmentectomy did not affect recurrence-free survival, by univariate analysis, in patients with p-step 1, p-step 3, or p-step 4. However, systematized segmentectomy or larger resection was significantly associated with patient recurrence-free survival, by univariate analysis, in patients with p-step 2. Multivariate analysis also showed systematized segmentectomy or larger resection as a significant independent prognostic factor in patients with p-step 2.

Conclusions

Systematized segmentectomy is suitable for patients with p-step 2 HCC according to this step classification.     

Surgical treatment for intrahepatic cholangiocarcinoma

Despite surgical treatment for intrahepatic cholangiocarcinoma (ICC) becoming more widely available, the prognosis after hepatic resection for ICC remains poor. Because ICC is relatively rare, the TNM staging system for ICC was finally established in the 2000s. Resection margin status and lymph node metastases are important prognostic factors after surgery for ICC; however, the true impact of wide resection margins or lymph node dissection on postoperative survival is unclear. Although adjuvant chemotherapy can improve the postoperative prognosis of patients with various types of cancer, no standard regimen has been developed for ICC. Over 50 % of patients suffer postoperative recurrence, even after curative resection, and no effective treatment for recurrent ICC has been established. Therefore, despite advances in imaging studies and hepatobiliary surgery, significant challenges remain in improving the prognosis of patients with ICC.     

Outcomes following resection of intrahepatic cholangiocarcinoma

ObjectivesThe aim of this analysis was to examine prognostic features and outcomes in patients undergoing resection for intrahepatic cholangiocarcinoma (ICC).MethodsA retrospective chart review was performed in all patients who underwent R0 or R1 resection for primary ICC between 1995 and 2011. Clinical data were abstracted and statistical analyses were conducted in the standard fashion.ResultsA total of 82 patients underwent curative hepatectomy for primary ICC; 51 patients in this cohort developed recurrence. The median follow-up of survivors was 27 months (range: 1–116 months). Recurrences were intrahepatic (65%), associated with multiple tumours (54%) and occurred during the first 2 years after hepatectomy (86%). The main factor associated with recurrence after resection was the presence of satellite lesions. Overall 5-year disease-free survival after primary resection was 16%. Factors associated with poor survival were transfusion and perineural invasion. Treatment of recurrence was undertaken in 89% of patients and repeat surgical resection was performed in 15 patients. The 3-year survival rate after recurrence was 25%. Prolonged survival after recurrence was associated with a solitary tumour recurrence.ConclusionsDespite curative resection of ICC, recurrence can be expected to occur in 79% of patients at 5 years. Predictors of survival and recurrence after resection vary in the literature. In patients with recurrence, selection of the optimal treatment remains challenging.