World Journal of Surgery

, Volume 42, Issue 10, pp 3331–3340 | Cite as

Surgical Indication for Advanced Intrahepatic Cholangiocarcinoma According to the Optimal Preoperative Carbohydrate Antigen 19-9 Cutoff Value

  • Yusuke Yamamoto
  • Teiichi Sugiura
  • Akiko Todaka
  • Yukiyasu Okamura
  • Takaaki Ito
  • Ryo Ashida
  • Yuko Kakuda
  • Yasuni Nakanuma
  • Katsuhiko Uesaka
Original Scientific Report



The indication of surgery in intrahepatic cholangiocarcinoma (ICC) patients with lymph node metastasis (LNM), macroscopic periductal infiltration (PI), and intrahepatic metastasis (IM) remains unclear.


Patients who underwent resection for mass-forming (MF) dominant ICC and unresected patients caused by LNM, IM, or locally advanced tumors (UR group) were enrolled. The significance of CA19-9 was investigated in advanced ICC.


Seventy-three patients who underwent resection and 20 UR patients were analyzed. Using the minimum p value approach based on the overall survival, the optimal CA19-9 cutoff value was 300 U/mL. The OS of the patients with CA19-9 < 37 U/mL (n = 26; MST, 49.6 months) and 37–300 U/mL (n = 28; MST, 45.1 months) was comparable (P = 0.842); however, the OS of the patients with CA19-9 = 37–300 U/mL was significantly better than that with CA19-9 ≥ 300 U/mL (n = 19; MST, 15.3 months; P < 0.001). CA19-9 > 300 U/mL, MF + PI, and IM were independently associated with OS. The OS of the patients with CA19-9 < 300 U/mL who developed LNM (MST, 34.0 months), MF + PI (MST, 32.9 months), or IM (MST, 35.2 months), or who required major vascular resection (MST, 45.1 months) was better than those with CA19-9 ≥ 300 U/mL who developed LNM (MST, 8.7 months; P = 0.005), MF + PI (MST, 7.5 months; P = 0.040), or IM (MST, 8.7 months; P = 0.001), or who required major vascular resection (MST, 14.8 months; P = 0.015); their prognosis was similar with the UR group.


Even if patients had ICC developing LNM, PI, or IM, or require major vascular resection, surgical resection can be indicated for patients with CA19-9 < 300 U/mL. However, the indications for either adjuvant therapy or resection should be carefully determined in patients with CA19-9 ≥ 300 U/mL.



Intrahepatic cholangiocarcinoma


Lymph node metastasis


Intrahepatic metastasis


Vascular invasion


Periductal infiltrating


European Association for the Study of Liver


Carbohydrate antigen 19-9




Intraductal growth




American Joint Committee on Cancer


International Union Against Cancer


Carcinoembryonic antigen


Portal vein resection


Hepatic artery resection


Inferior vena cava resection



This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Yusuke Yamamoto
    • 1
  • Teiichi Sugiura
    • 1
  • Akiko Todaka
    • 2
  • Yukiyasu Okamura
    • 1
  • Takaaki Ito
    • 1
  • Ryo Ashida
    • 1
  • Yuko Kakuda
    • 3
  • Yasuni Nakanuma
    • 3
  • Katsuhiko Uesaka
    • 1
  1. 1.Division of Hepato-Biliary-Pancreatic SurgeryShizuoka Cancer CenterSunto-NagaizumiJapan
  2. 2.Division of GI OncologyShizuoka Cancer CenterSunto-NagaizumiJapan
  3. 3.Division of PathologyShizuoka Cancer CenterSunto-NagaizumiJapan

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