Journal Reading

June 2016

Surgical Treatment of
Intrahepatic
Cholangiocarcinoma : A
Retrospective Cohort Study

Embong Wicaksono*
Source:
L. Laca, I. Dedinska, B. Palkoci, J.Miklusica, J. Janik
International Journal of Surgery Open 4 : 2016: 10-14

SURGERY DEPARTMENT
M. HOESIN HOSPITAL PALEMBANG
MEDICAL FACULTY OF SRIWIJAYA UNIVERSITY
2017
 I. Introduction

IHHC is 2nd most of the liver primary ca after HHC

Its From biliary epithelium cells of IHBD 2nd br/more

Biologically agressive, Surgical removal

Frequently found in late study/ >curative
Menifested in distant metastases theurapeutik

EHCC-> Incidence IHHC EHHC ->

IHHC -> Incidence
+ mortality Same microscopic
+ mortality growing
decreased morphology
 Primary Chronic inflamation
USA sclerosing Damages DNA
0.85/100.000 cholangitis, cholangiocytes
cases congenital biliary Stimulation of the
cell proliferation
cystic desease, Malign
Thailand cirrhosis, HBV, transformation
96/100.000 HCV, Benign Oncoges >>
cases tumor of bile Supressing tumor
duct, infection genes<<
 Diagnostic
History and complete clinical examination,
Biochemical examinations bilirubin, hepatal
enzymes, oncomarkers, and radiologic imaging
method
Metastatic intervention to liver by other tumors
should also be excluded
Biopsy (non resectable tumor)
Staging laparoscopy in order to exclude
extrahepatic dissemination of tumor
 Diagnostic
CA19-9 ->cholangiocarcinoma, ca. of the upper GI tract,
smokers, cholangoitis and cholestasis.
CEA, IL 6, Trypsinogen II ->sensitivity and specificity is lower
Spiral CT5 with three-stage contrast, MR, MRCP and
PETCT.
PET-CT is useful for recurrence,detection of affected lymph
node (LG), and distant metastases
G1 (well differentiated cholangiocarcinoma), G2 (medium
differentiated cholangiocarcinoma), and G3 (low
differentiated cholangiocarcinoma).
Definition of T, N, and M factors for Intrahepatic
Cholangiocarcinoma
Staging System for Intrahepatic
Cholangiocarcinoma
 2. Material and
Methods

This is a retrospective analysis of patients who

underwent surgical treatment of cholangiocarcinoma
at Department of Surgery and Transplantation
Center, University Hospital Martin.
 2. Material and
Methods

Department of Surgery and Transplantation Center,

University Hospital Martin
1/1/2004 31/12/2014

We evaluated the 1-year and

5-year survival of the patients The value of P <
411 patients = according to radicality of 0.05 is considered
33 patients resections, the level of
statistically
(8%)->IHCC differentiation of tumor
significant.
(grading), and according to
positivity of lymph node
 3. Result

The average age

was 59.6 11.4
years

males 46.2%,
Resection
females 53.8%.

males was 58
13.2, and females
61 9.8 years.

R0 = 20 Patient
R1 = 8 Patient
R2 = 5 patient
One-year survival of patients with IHCC depending on the
radicality of resection.

65%

62%

20%
five-year survival of patients with IHCC depending on the
radicality of resection.

52%

0%
one-year survival of patients depending on the tumor
grading

G1 = 8 Patient
G2 = 8 Patient
G3 = 17 patient
five-year survival of patients depending on the tumor
grading

G1 = 8 Patient
G2 = 8 Patient
G3 = 17 patient

50%

12%
0%
1-year survival of patients according to lymph node
positivity

Lymph node +: 16
Lympnode - : 17
5-year survival of patients according to lymph node
positivity

Lymph node +: 16
Lympnode - : 17
 Discussion
Treatment of IHCC -> primarily surgical
Extensive hepatectomy ->R0
Radical R0 resection -> survival of patients
5-year survival with complete resection = 13%-
60%; in our group it was 52%
Variability of survival->affected lymph node
Many departments->the affected lymph node
represents contraindication for resection
 Discussion
Positive resection edge, the growth type of tumor,
vascular invasion, metastases in lymph node, and
increased levels of CA19-9 ->negative prognostic
factor after resection
Lack of effective neoadjuvant and adjuvant
chemotherapy
Patients with R1 resection and positive lymph node,
the adjuvant chemotherapy improves the survival
and reduces recurrence
 Discussion
Adjuvant chemotherapy is recommended -> IHCC and EHCC,
- R1
- R0 with positive lymph node
Locally advanced IHCC after R2 resection or primary non-
resectable tumor-> the surgical treatment is not indicated but
chemoradiation therapy which may prolong the survival and
improve the quality of life.
 Discussion
Liver transplant = 5-year survival 23%.
Recurrence = 40%- 80% within 5 years
after resection
The ablation -> rarely applied ->firm
consistence of tumor and the size of
tumor.
TERIMA KASIH