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Results of Aggressive Surgical Management

Daniel Cherqui, MD; Bassam Tantawi, MD; Rafael Alon, MD; Pascal Piedbois, MD; Alain Rahmouni, MD; Daniel Dhumeaux, MD; Michel Julien, MD; Pierre-Louis Fagniez, MD

Arch Surg. 1995;130(10):1073-1078.

Abstract
Objective
To report the results of a deliberately aggressive surgical management in patients with intrahepatic cholangiocarcinoma.

Design
A case series of patients with intrahepatic cholangiocarcinoma.

Setting
A tertiary care university hospital in a metropolitan area.

Patients
From 1989 to 1993, 19 patients with intrahepatic cholangiocarcinoma underwent laparotomy, with a 74% resectability rate (14 liver resections). In addition, two selected patients with a slow-growing tumor underwent orthotopic liver transplantation after limited recurrence following resection in one case and after exploratory laparotomy in the other.

Interventions
The 14 liver resections included six right or left hepatectomies and eight extended right or left hepatectomies. Total vascular exclusion of the liver was used in nine cases (64%) and resection of the biliary confluence with reconstruction was used in six cases (43%).

Results
There was one postoperative death (7%). There were four postoperative biliary fistulas (28%). Overall actuarial 1- and 2-year survival rates were 58% and 32%, respectively. The 1- and 2-year survival rates were 100% after curative resection (no lymph node invasion, clearance margin of 1 cm, and solitary tumor [five cases]) and 48% and 10% after palliative resection. Median survival was 14 months for the whole series and 27 and 9 months following curative and palliative resections, respectively. The two liver transplant recipients are alive and free of disease at 25 and 31 months.

Conclusion
These results support aggressive surgical management in patients with intrahepatic cholangiocarcinoma, including complex liver resection procedures and selective use of orthotopic liver transplantation.

(Arch Surg. 1995;130:1073-1078)

Author Affiliations
From the Departments of Digestive Surgery (Drs Cherqui, Tantawi, Alon, Julien, and Fagniez), Oncology (Dr Piedbois), Radiology (Dr Rahmouni), and Hepatology (Dr Dhumeaux), Hôpital Henri Mondor—Université Paris XII, Créteil, France.

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