Clinical

Radical resection improves survival with intrahepatic cholangiocarcinoma

Last Updated: 2012-08-21 15:20:19 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Radical resection of intrahepatic cholangiocarcinoma (IHC), along with lymphadenectomy in some patients, can improve long-term survival, according to a report from Italy.

Dr. Lorenzo Capussotti from Ospedale Mauriziano "Umberto I," Torino, Italy, and colleagues, who published the report, say the incidence of IHC and its associated mortality have been rising worldwide.

Their study analyzed data on 434 patients evaluated and treated at tertiary hepatobiliary centers in Italy. Just over a third of patients (151, 34.8%) had postoperative complications, most related to the liver (43.9%) or infections (18.7%). A fifth of the patients developed major complications with a reoperation rate of 3.7% (16 patients).

After resection, 124 patients received either chemotherapy or radiation, as reported online Monday in Archives of Surgery.

Among patients who had some form of lymph node dissection, 36.9% had metastases. Fifty-two patients (12.0%) had a positive resection margin.

The median survival was 33 months. Overall survival estimates were 82.3% at one year, 47.1% at three years, and 32.9% at five years.

Survival estimates were higher for patients with complete (R0) resection: 39 months median survival, with survival estimates of 84.8% at year, 50.6% at three years, and 39.8% at five years.

Among 47 actual five-year survivors, 31 had no evidence of disease, for a minimum cure rate of 17.7%.

Independent predictors of poor survival in multivariate analysis included lymph node metastases, multiple tumors, and an elevated preoperative cancer antigen 19-9 level.

Because of the presence of lymph node metastases in a significant proportion of the patients and their impact on survival, the researchers support routine lymphadenectomy.

"One of the limitations of our study," they note, "is that we could not determine the site of lymph node metastases in patients with N1 disease and, thus, the most appropriate extent of a lymphadenectomy. Nevertheless, we believe that a systematic lymph node dissection should at least include the first echelon lymph nodes."

"Hepatic resection remains the only chance of a cure for patients with IHC," the investigators conclude. "Our results support an aggressive surgical approach that results in a high R0 resection rate and enhanced long-term survival."

Dr. Capussotti did not respond to a request for comment.

SOURCE: http://bit.ly/TSrgMK

Arch Surg 2012.