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Surgical Strategies for Intrahepatic Cholangiocarcinoma With Hepatolithiasis

By: Celeste L. Dixon
Posted: Monday, April 10, 2023

In a study of 147 adults who had primary intrahepatic cholangiocarcinoma with hepatolithiasis and were treated with either anatomic or nonanatomic resection, anatomic resection was associated with better long-term survival outcomes. The exception was in patients with lymph node metastases, for whom the type of resection exhibited no significant association with outcomes, according to Jun-Yi Wu, MD, PhD, of Fujian Medical University, Fuzhou, China, and colleagues in Frontiers in Medicine. In all patients, complete removal of the tumor was accomplished with a free microscopic margin.

Those who underwent anatomic resection had better 1-, 3-, and 5-year overall survival rates (78.7% vs. 61.2%; 58.9% vs. 25.4%; and 28.5% vs. 8.8%, respectively) and recurrence-free survival rates (59.5% vs. 38.2%; 36.5% vs. 12.1%; and 20.5% vs. 6.9%, respectively) than those who underwent nonanatomic resection. After propensity score matching, which involved 100 of the enrolled patients, the P values for overall survival and recurrence-free survival were .016 and .010, respectively, favoring those who had anatomic resection. All patients had their surgeries between 2012 and 2021 at three high-volume Chinese hospitals.

According to the study authors, multivariate analysis indicated that carbohydrate antigen (CA) 19-9 (> 39 U/L), microvascular invasion, lymph node metastases, and nonanatomic resection were independent risk factors for poorer recurrence-free survival and overall survival rates. Having multiple tumors was also an independent risk factor for poorer overall survival.

Anatomic liver resection was defined as a resection involving “systematic removal of the Couinaud segment(s), which include the tumor together with the tumor-bearing portal vein and hepatic territory,” explained Dr. Wu and coauthors. Nonanatomic resections included all others “that were not in accordance with the anatomical distribution of the portal vein branches.” In all cases, they noted, regional lymphadenectomies were performed if lymph node metastasis was suspected or diagnosed either before or during surgery.

Disclosure: The study authors reported no conflicts of interest.

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