Annals of Surgical Oncology

, Volume 20, Issue 6, pp 2023–2028 | Cite as

Role of Major Vascular Resection in Patients with Intrahepatic Cholangiocarcinoma

  • Shahzad M. Ali
  • Clancy J. Clark
  • Victor M. Zaydfudim
  • Florencia G. Que
  • David M. Nagorney
Hepatobiliary Tumors



Historically, direct vascular extension of intrahepatic cholangiocarcinoma (ICC) has often been considered a contraindication to resection. However, recent studies have suggested safety and efficacy of hepatectomy with major vascular resection in this patient population. The aim of this study was to investigate the short and long-term clinical outcomes of patients with ICC treated with hepatectomy with or without major vascular resection.


This retrospective cohort study included all patients with ICC who underwent major liver resection between 1997 and 2011. Clinical outcomes were compared between patients treated with major hepatectomy and vascular resection (VR) and those without vascular resection (NVR). Kaplan–Meier survival estimates were used to compare overall survival (OS) between patients in VR and NVR groups.


A total of 121 patients (median age 60; 42 % male) underwent major hepatectomy for ICC. Major vascular resection was performed in 14 (12 %) patients (IVC = 9, PV = 5). Age, sex, American Society of Anesthesiology (ASA) class, tumor size, lymph node status, and CA-19 9 were comparable (all p ≥ 0.184) between VR and NVR groups. Major postoperative complications (Dindo-Clavien ≥3) occurred in four (29 %) patients in the VR group and 17 (16 %) in the NVR group (p = 0.263). Postoperative death occurred in one patient in the VR group due to liver failure. Median OS did not differ between patients treated with and without vascular resection (32 vs. 49 months, respectively, p = 0.268).


Hepatectomy combined with IVC or PV resection can be safely performed in patients with ICC. Major vascular resection does not affect short and long-term outcomes in this patient population.


Overall Survival Inferior Vena Cava Major Hepatectomy Intrahepatic Cholangiocarcinoma Bile Duct Resection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Sempoux C, Jibara G, Ward SC, et al. Intrahepatic cholangiocarcinoma: new insights in pathology. Semin Liver Dis. 2011;31:49–60.PubMedCrossRefGoogle Scholar
  2. 2.
    Malhi H, Gores GJ. The modern diagnosis and therapy of cholangiocarcinoma [review]. Aliment Pharmacol Ther. 2006;23:1287–96.PubMedCrossRefGoogle Scholar
  3. 3.
    Khan SA, Toledano MB, Taylor-Robinson SD. Epidemiology, risk factors, and pathogenesis of cholangiocarcinoma. HPB (Oxford). 2008;10:77–82.CrossRefGoogle Scholar
  4. 4.
    Endo I, Gonen M, Yopp AC, et al. Intrahepatic cholangiocarcinoma: rising frequency, improved survival, and determinants of outcome after resection. Ann Surg. 2008;248:84–96.PubMedCrossRefGoogle Scholar
  5. 5.
    Tan JC, Coburn NG, Baxter NN, Kiss A, Law CH. Surgical management of intrahepatic cholangiocarcinoma—a population-based study. Ann Surg Oncol. 2008;15:600–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Konstadoulakis MM, Roayaie S, Gomatos IP, et al. Fifteen-year, single-center experience with the surgical management of intrahepatic cholangiocarcinoma: operative results and long-term outcome. Surgery. 2008;143:366–74.PubMedCrossRefGoogle Scholar
  7. 7.
    Lang H, Sotiropoulos GC, Sgourakis G, et al. Operations for intrahepatic cholangiocarcinoma: single-institution experience of 158 patients. J Am Coll Surg. 2009;208:218–28.PubMedCrossRefGoogle Scholar
  8. 8.
    Guglielmi A, Ruzzenente A, Campagnaro T, et al. Intrahepatic cholangiocarcinoma: prognostic factors after surgical resection. World J Surg. 2009;33:1247–54.PubMedCrossRefGoogle Scholar
  9. 9.
    Patel T. Increasing incidence and mortality of primary intrahepatic cholangiocarcinoma in the United States. Hepatology. 2001;33:1353–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Jarnagin WR, Weber S, Tickoo SK, et al. Combined hepatocellular and cholangiocarcinoma: demographic, clinical, and prognostic factors. Cancer. 2002;94:2040–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Yedibela S, Demir R, Zhang W, Meyer T, Hohenberger W, Schonleben F. Surgical treatment of mass-forming intrahepatic cholangiocarcinoma: an 11-year Western single-center experience in 107 patients. Ann Surg Oncol. 2009;16:404–12.PubMedCrossRefGoogle Scholar
  12. 12.
    Bower TC, Nagorney DM, Toomey BJ, et al. Vena cava replacement for malignant disease: is there a role? Ann Vasc Surg. 1993;7:51–62.PubMedCrossRefGoogle Scholar
  13. 13.
    Huguet C, Ferri M, Gavelli A. Resection of the suprarenal inferior vena cava. The role of prosthetic replacement. Arch Surg. 1995;130:793–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Miller CM, Schwartz ME, Nishizaki T. Combined hepatic and vena caval resection with autogenous caval graft replacement. Arch Surg. 1991;126:106–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Nuzzo G, Giordano M, Giuliante F, Lopez-Ben S, Albiol M, Figueras J. Complex liver resection for hepatic tumours involving the inferior vena cava. Eur J Surg Oncol. 2011;37:921–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Sano T, Shimada K, Nara S, Esaki M, Sakamoto Y, Kosuge T. Hepatobiliary resection with inferior vena cava resection and reconstruction using an autologous patch graft for intrahepatic cholangiocarcinoma. Langenbecks Arch Surg. 2008;393:599–603.PubMedCrossRefGoogle Scholar
  17. 17.
    Hemming AW, Reed AI, Langham MR Jr, Fujita S, Howard RJ. Combined resection of the liver and inferior vena cava for hepatic malignancy. Ann Surg. 2004;239:712–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Bower TC, Nagorney DM, Cherry KJ Jr, et al. Replacement of the inferior vena cava for malignancy: an update. J Vasc Surg. 2000;31:270–81.PubMedCrossRefGoogle Scholar
  19. 19.
    Igami T, Nishio H, Ebata T, et al. Surgical treatment of hilar cholangiocarcinoma in the “new era”: the Nagoya University experience. J Hepatobiliary Pancreat Sci. 2010;17:449–54.PubMedCrossRefGoogle Scholar
  20. 20.
    Neuhaus P, Thelen A, Jonas S, et al. Oncological superiority of hilar en bloc resection for the treatment of hilar cholangiocarcinoma. Ann Surg Oncol. 2012;19:1602–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Edge SB, Compton CC; American Joint Committee on Cancer. The 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17:1471–4.PubMedCrossRefGoogle Scholar
  22. 22.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6,336 patients and results of a survey. Ann Surg. 2004;240:205–13.PubMedCrossRefGoogle Scholar
  23. 23.
    Dindo D, Clavien PA. What is a surgical complication? World J Surg. 2008;32:939–41.PubMedCrossRefGoogle Scholar
  24. 24.
    Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.PubMedCrossRefGoogle Scholar
  25. 25.
    Sarmiento JM, Bower TC, Cherry KJ, Farnell MB, Nagorney DM. Is combined partial hepatectomy with segmental resection of inferior vena cava justified for malignancy? Arch Surg. 2003;138:624–30.PubMedCrossRefGoogle Scholar
  26. 26.
    Farges O, Fuks D, Boleslawski E, et al. Influence of surgical margins on outcome in patients with intrahepatic cholangiocarcinoma: a multicenter study by the AFC-IHCC-2009 study group. Ann Surg. 2011;254:824–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Clark CJ, Wood-Wentz CM, Reid-Lombardo KM, Kendrick ML, Huebner M, Que FG. Lymphadenectomy in the staging and treatment of intrahepatic cholangiocarcinoma: a population-based study using the National Cancer Institute SEER database. HPB (Oxford). 2011;13:612–20.CrossRefGoogle Scholar
  28. 28.
    de Jong MC, Nathan H, Sotiropoulos GC, et al. Intrahepatic cholangiocarcinoma: an international multi-institutional analysis of prognostic factors and lymph node assessment. J Clin Oncol. 2011;29:3140–5.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2012

Authors and Affiliations

  • Shahzad M. Ali
    • 1
  • Clancy J. Clark
    • 1
  • Victor M. Zaydfudim
    • 1
  • Florencia G. Que
    • 1
  • David M. Nagorney
    • 1
  1. 1.Division of Gastroenterologic and General SurgeryMayo ClinicRochesterUSA

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