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Intrahepatic Cholangiocarcinoma pp 67–83Cite as

Surgical Treatment

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Abstract

Surgical resection is the mainstay of treatment for intrahepatic cholangiocarcinoma (ICC) and generally offers a 5-year overall survival probability of approximately 15–40%. However, approximately 70% of patients will recur, the majority of them within 2 years from surgery. As such, patient selection and the addition of adjuvant and/or neoadjuvant therapies are critical. Current consensus supports that surgery should be offered if disease clearance with negative resection margins can be achieved, while maintaining sufficient future liver remnant and function. Patients with intrahepatic metastases or extrahepatic disease (including nodal disease beyond the porta hepatis) are not candidates for curative surgery. At this point in time, the optimal margin width has not been clearly defined and more studies are needed in this direction. Major vascular invasion is not a contraindication to surgery, provided vascular reconstruction (if needed) can be performed safely. In addition, routine dissection of porta hepatis nodes provides highly prognostic information for staging purposes and should be considered standard of care, although its therapeutic value is not proven. Multifocal disease is generally associated with poor outcomes, but a small subset of patients with limited satellitosis (as opposed to true intrahepatic metastases) may benefit from surgery. Further study is warranted to refine selection criteria with regard to tumor multifocality. Liver transplantation has been historically associated with poor outcomes for ICC, but may be an option, for selected patients with very early-stage disease on a protocol-only basis.

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Authors and Affiliations

  1. John L. Cameron Division of Pancreatic and Hepatobiliary Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA

    Georgios Antonios Margonis

  2. Department of Surgery, Stanford University Hospital, Stanford, CA, USA

    George A. Poultsides

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  1. Georgios Antonios Margonis
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Correspondence to George A. Poultsides .

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Editors and Affiliations

  1. Wexner Medical Center, The Ohio State University, Columbus, OH, USA

    Timothy M. Pawlik

  2. Wexner Medical Center, The Ohio State University, Columbus, OH, USA

    Jordan M. Cloyd

  3. Wexner Medical Center, The Ohio State University, Columbus, OH, USA

    Mary Dillhoff

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Margonis, G.A., Poultsides, G.A. (2019). Surgical Treatment. In: Pawlik, T., Cloyd, J., Dillhoff, M. (eds) Intrahepatic Cholangiocarcinoma. Springer, Cham. https://doi.org/10.1007/978-3-030-22258-1_5

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