Intrahepatic cholangiocarcinoma. Results of aggressive surgical management
D. Cherqui, B. Tantawi, R. Alon, P. Piedbois, A. Rahmouni, D. Dhumeaux, M. Julien and P. L. Fagniez
Department of Digestive Surgery, Hopital Henri Mondor-Universite Paris XII, Creteil, France.
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 < or = 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.
