Surgical Treatment of Intrahepatic Cholangiocarcinoma

Abstract

The second most common primary liver cancer is intrahepatic cholangiocarcinoma (iCCA). The only potentially curative treatment for iCCA is surgical resection, although the majority of patients will present with unresectable, locally advanced, or metastatic disease at diagnosis. The focus of surgical management is margin-negative resection with preservation of an adequate liver remnant volume and function. Extensive liver resection including adjacent involved structures such as the extrahepatic bile duct, major vessels, and diaphragm may be required to achieve negative resection margins. For patients with high-risk features, the routine use of diagnostic laparoscopy with the selective use of laparoscopic ultrasonography is recommended to identify occult metastatic disease.Among the prognostic factors such as lymph node (LN) involvement, tumor size, multicentricity, margin status, tumor differentiation, and vascular invasion, LN metastasis is the most important prognostic factor for patients undergoing curative-intent resection. Regional lymphadenectomy is recommended at the time of hepatectomy due to the high incidence of LN metastasis and its prognostic relevance. Even in patients who undergo R0 resection, the recurrence rates are high and the long-term survival remains poor. Despite the poor outcomes of liver transplantation for iCCA, liver transplantation may be a therapeutic option for selected patients with early-stage iCCA, especially for patients with an adequate response to neoadjuvant therapy.