[Skip to Content]
Sign In
Individual Sign In
Create an Account
Institutional Sign In
OpenAthens Shibboleth
[Skip to Content Landing]
October 1995

Intrahepatic CholangiocarcinomaResults of Aggressive Surgical Management

Author Affiliations

From the Departments of Digestive Surgery (Drs Cherqui, Tantawi, Alon, Julien, and Fagniez), Oncology (Dr Piedbois), Radiology (Dr Rahmouni), and Hepatology (Dr Dhumeaux), Hôpital Henri Mondor—Université Paris XII, Créteil, France.

Arch Surg. 1995;130(10):1073-1078. doi:10.1001/archsurg.1995.01430100051011

Objective:  To report the results of a deliberately aggressive surgical management in patients with intrahepatic cholangiocarcinoma.

Design:  A case series of patients with intrahepatic cholangiocarcinoma.

Setting:  A tertiary care university hospital in a metropolitan area.

Patients:  From 1989 to 1993, 19 patients with intrahepatic cholangiocarcinoma underwent laparotomy, with a 74% resectability rate (14 liver resections). In addition, two selected patients with a slow-growing tumor underwent orthotopic liver transplantation after limited recurrence following resection in one case and after exploratory laparotomy in the other.

Interventions:  The 14 liver resections included six right or left hepatectomies and eight extended right or left hepatectomies. Total vascular exclusion of the liver was used in nine cases (64%) and resection of the biliary confluence with reconstruction was used in six cases (43%).

Results:  There was one postoperative death (7%). There were four postoperative biliary fistulas (28%). Overall actuarial 1- and 2-year survival rates were 58% and 32%, respectively. The 1- and 2-year survival rates were 100% after curative resection (no lymph node invasion, clearance margin of ≤1 cm, and solitary tumor [five cases]) and 48% and 10% after palliative resection. Median survival was 14 months for the whole series and 27 and 9 months following curative and palliative resections, respectively. The two liver transplant recipients are alive and free of disease at 25 and 31 months.

Conclusion:  These results support aggressive surgical management in patients with intrahepatic cholangiocarcinoma, including complex liver resection procedures and selective use of orthotopic liver transplantation.(Arch Surg. 1995;130:1073-1078)

Craig JR, Peters RL, Edmonson HA.  Tumors of the Liver and Intrahepatic Bile Ducts . Washington, DC: Armed Forces Institute of Pathology ; 1989.
The Liver Study Group of Japan.  Primary liver cancers in Japan: sixth report . Cancer . 1987;60:1400-1411.Article
Nakajima T, Kondo Y, Miyazaki, Okui K.  A histopathologic study of 102 cases of intrahepatic cholangiocarcinoma: histologic classification and modes of spreading . Hum Pathol . 1988;19:1228-1234.Article
Nesbit GM, Johnson CD, James EM, McCarthy RL, Nagorney DM, Bender CE.  Cholangiocarcinoma: diagnosis and evaluation of resectability by CT and sonography as procedures complementary to cholangiography . AJR Am J Roentgenol . 1988;151:933-938.Article
Iwatsuki S, Starzl TE.  Personal experience with 411 hepatic resections . Ann Surg . 1988:208:421-432.Article
Kawarada Y, Mizumoto R.  Diagnosis and treatment of cholangiocellular carcinoma of the liver . Hepatogastroenterology . 1990;37:176-181.
Yamamoto J, Kosuge T, Takayama T, et al.  Surgical treatment of intrahepatic cholangiocarcinoma: four patients surviving more than five years . Surgery . 1992; 111:617-622.
Chen MF, Jan YY, Wang CS, Jeng LB, Hwang TL.  Clinical experience in 20 hepatic resections for peripheral cholangiocarcinoma . Cancer . 1989;64:2226-2232.Article
Bismuth H, Castaing D, Garden OJ.  Major hepatic resection under total vascular exclusion . Ann Surg . 1989;201:13-19.Article
Huguet C, Addario-Chieco P, Gavelli A, Arrigo E, Harb J, Clement RR.  Technique of hepatic vascular exclusion for extensive liver resection . Am J Surg . 1992;163:602-605.Article
Baer HU, Stain SC, Dennison AR, Eggers B, Blumgart LH.  Improvements in survival by aggressive resections of hilar cholangiocarcinoma . Ann Surg . 1993; 217:20-27.Article
Nakamura S, Sakaguchi S, Kitazawa S, Koyano K, Muro H.  Hepatic vein reconstruction for preserving remnant liver function . Arch Surg . 1990;125:1455-1459.Article
Todani T, Tabuchi K, Watanabe Y, et al.  Carcinoma arising in the wall of congenital choledocal cysts . Cancer . 1979;44:1134-1141.Article
Bloustein PA.  Association of carcinoma with congenital cystic conditions of the liver and bile ducts . Am J Gastroenterol . 1977;67:40-46.
Rosen CB, Nagorney DM, Wiesner RH, Coffey RJ, La Russo NF.  Cholangiocarcinoma complicating primary sclerosing cholangitis . Ann Surg . 1991:213:21-25.Article
Chen PH, Lo HW, Wang CL, et al.  Cholangiocarcinoma in hepatolithiasis . J Clin Gastroenterol . 1984;6:539-547.Article
Belamaric J.  Intrahepatic bile duct carcinoma and C sinensis infection in Hong Kong . Cancer . 1973;31:468-473.Article
Rubel LR, Ishak KG.  Thorotrast-associated cholangiocarcinoma: an epidemiologic and clinicopathologic study . Cancer . 1982;50:1408-1415.Article
Ros PR, Buck JL, Goodman ZD, Viamonte Ros AM, Olmsted WW.  Intrahepatic cholangiocarcinoma: radiologic-pathologic correlation . Radiology . 1988:167:689-693.Article
Takayasu K, Muramatsu Y, Shima Y, Moriyama N, Yamada T, Makuuchi M.  Hepatic lobar atrophy following obstruction of the ipsilateral portal vein from hilar cholangiocarcinoma . Radiology . 1986;160:189-193.Article
Thorsen MK, Quiroz F, Lawson TL, Smith DF, Foley WD, Stewart ET.  Primary biliary carcinoma: CT evaluation . Radiology . 1984;152:479-483.Article
Cherqui D, Piedbois P, Pierga JY, et al.  Multimodal adjuvant treatment and liver transplantation for advanced hepatocellular carcinoma: a pilot study . Cancer . 1994;73:2721-2726.Article
Nimura Y, Hayakawa N, Kamiya J, Kondo S, Shionoya S.  Hepatic segmentectomy with caudate lobe resection for bile duct carcinoma of the hepatic hilus . World J Surg . 1990;14:535-544.Article
Makuuchi M, Le Thai B, Takayasu K, et al.  Preoperative portal embolization to increase the safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report . Surgery . 1990;107:521-527.
Chapman WC, Sharp KW, Weaver F, Sawyers JL.  Tumor seeding from percutaneous biliary catheters . Ann Surg . 1989;209:708-713.Article
Hamlin JA, Friedman M, Stein MG, Bray JF.  Percutaneous biliary drainage: complications of 118 consecutive catheterizations . Radiology . 1986;158:199-202.Article
O'Grady JO, Poison RJ, Rolles K, Calne RY, Williams R.  Liver transplantation for malignant disease: results in 93 consecutive patients . Ann Surg . 1988:207:373-379.Article
Ringe B, Wittekind C, Bechstein WO, Bunzendahl H, Pichlmayr R.  The role of liver transplantation in hepatobiliary malignancy: a retrospective analysis of 95 patients with particular regard to tumor stage and recurrence . Ann Surg . 1989; 209:88-98.Article
Ismail T, Angrisani L, Gunson BK, et al.  Primary hepatic malignancy: the role of liver transplantation . Br J Surg . 1990;77:983-987.Article
Iwatsuki S, Gordon RD, Shaw BW, Starzl TE.  Role of liver transplantation in cancer therapy . Ann Surg . 1985;202:401-407.Article