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Intrahepatic Cholangiocarcinoma: Primary Liver Resection and Aggressive Multimodal Treatment of Recurrence Significantly Prolong Survival

Ercolani, Giorgio MD*; Vetrone, Gaetano MD*; Grazi, Gian Luca MD*; Aramaki, Osamu MD*; Cescon, Matteo MD*; Ravaioli, Matteo MD*; Serra, Carla MD†; Brandi, Giovanni MD‡; Pinna, Antonio Daniele MD*

doi: 10.1097/SLA.0b013e3181e462e6
Original Articles

Objective: To evaluate the results of surgical therapy for intrahepatic cholangiocarcinoma (ICC), the incidence and the management of recurrence, and to analyze the change in approach during 2 different periods.

Design: Retrospective study.

Patients and Methods: Patient and tumor characteristics, and overall and disease-free survival were analyzed in a series of 72 consecutive patients who underwent hepatic resection for ICC. Several factors likely to influence survival after resection were evaluated. Patients were divided into 2 groups according to the year of operation (before and after 1999). Management of recurrence and survival after recurrence were also analyzed.

Results: The 3- and 5-year overall survival rates were 62% and 48%, whereas the 3- and 5-year disease-free survival rates were 30% and 25%, respectively. The median survival time was 57.1 months. Patient and histologic characteristics before and after 1999 were similar. Survival was significantly better among patients operated after 1999, who were node-negative, did not receive blood transfusion, and underwent adjuvant chemotherapy. The overall recurrence rates before and after 1999 were comparable (66.6% and 50%, P = 0.49). The most frequent site of recurrence was the liver. A significantly large number of patients received treatment for recurrence after 1999 (81.5%) compared with the first period (8.3%). The overall 3-year survival rate after recurrence was 46%. After 1999, there was a significant improvement in 3-year survival after recurrence (56%) compared with patients operated before 1999 (0%, P = 0.004); the median survival time from the diagnosis of recurrence increased from 20 months to 66 months in the second group.

Conclusions: Although recurrence rate represents a frequent problem in ICC, an aggressive approach to recurrence can significantly prolong survival.

Management of recurrence and survival after recurrence were evaluated in a series of 72 patients who underwent hepatic resection for intrahepatic cholangiocarcinoma. Although tumor recurrence still represents a serious problem, the management of recurrence was more aggressive after 1999 resulting in significantly improved survival.

From the *Liver and Multiorgan Transplant Unit, Department of Surgery and Transplantation, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy; Departments of †Internal Medicine and Hepatology and ‡Hematology and Oncologic Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.

Reprints: Giorgio Ercolani, MD, Department of Surgery and Transplantation, Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy. E-mail: giorgio.ercolani@aosp.bo.it.

© 2010 Lippincott Williams & Wilkins, Inc.