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Background and Purpose <p>Surgery for locally advanced intrahepatic cholangiocarcinoma (LAICC) requires extended liver resections, often associated with vascular and/or biliary reconstruction. The benefits of these high-risk operations are still debated. The objective of this study was to analyze short, long-term outcomes, and futility after surgery for LAICC.</p> Methods <p>A retrospective single-center study on the 2013–2024 period was conducted. LAICC was defined as mass-forming intrahepatic tumors 5 cm or more in size with hepatic vein/IVC contact or hepatic hilum contact or both and requiring extended liver resection (five segments or more). Futility was defined as deaths within 90 days or recurrence within 6 months of surgery.</p> Results <p>39 consecutive patients were analyzed, including (29) 74% women with a median age of 66 years (38–83 years). In 34 (88%) patients, a trisectionectomy (H145678 or H123458) was performed. Major vascular or biliary recontruction was required in 43.5% and 67%, respectively. Overall morbidity was 56%, with severe morbidity occurring in 8 (20%). The 90-day mortality was 5%. Median overall survival and recurrence-free survival was estimated at 58 and 23 months, respectively. Overall rate of futility was 15.4%. N+ has been shown to be the main factor affecting survival (<i>p</i> = 0.03 for overall survival and <i>p</i> = 0.01 for recurrence-free survival). R1 resection had no impact of overall or recurrence-free survival.</p> Conclusions <p>Our study supports an aggressive surgical approach for LAICC. Anticipated R1 resection by necessity should not be considered a contraindication to surgery.</p>

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Is R1 Extended Liver Resection for Locally Advanced Intrahepatic Cholangiocarcinoma Justified? Nodal Status Not Margin Drives Prognosis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月29日

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  • Edoardo Maria Muttillo,
  • Daniel Cherqui,
  • Marc-Anthony Chouillard,
  • Nicolas Golse,
  • Oriana Ciacio,
  • Gabriella Pittau,
  • Chady Salloum,
  • Daniel Azoulay,
  • Marc-Antoine Allard,
  • Daniel Pietrasz,
  • René Adam,
  • Eric Vibert,
  • Pascal Hammel,
  • Maïté Lewin,
  • Alina Pascale,
  • Olivier Rosmorduc,
  • Antonio Sa Cunha

摘要

Background and Purpose

Surgery for locally advanced intrahepatic cholangiocarcinoma (LAICC) requires extended liver resections, often associated with vascular and/or biliary reconstruction. The benefits of these high-risk operations are still debated. The objective of this study was to analyze short, long-term outcomes, and futility after surgery for LAICC.

Methods

A retrospective single-center study on the 2013–2024 period was conducted. LAICC was defined as mass-forming intrahepatic tumors 5 cm or more in size with hepatic vein/IVC contact or hepatic hilum contact or both and requiring extended liver resection (five segments or more). Futility was defined as deaths within 90 days or recurrence within 6 months of surgery.

Results

39 consecutive patients were analyzed, including (29) 74% women with a median age of 66 years (38–83 years). In 34 (88%) patients, a trisectionectomy (H145678 or H123458) was performed. Major vascular or biliary recontruction was required in 43.5% and 67%, respectively. Overall morbidity was 56%, with severe morbidity occurring in 8 (20%). The 90-day mortality was 5%. Median overall survival and recurrence-free survival was estimated at 58 and 23 months, respectively. Overall rate of futility was 15.4%. N+ has been shown to be the main factor affecting survival (p = 0.03 for overall survival and p = 0.01 for recurrence-free survival). R1 resection had no impact of overall or recurrence-free survival.

Conclusions

Our study supports an aggressive surgical approach for LAICC. Anticipated R1 resection by necessity should not be considered a contraindication to surgery.