Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 9/2019

01-09-2019 | Original Article

Prognostic Impact of Tumor Multinodularity in Intrahepatic Cholangiocarcinoma

Authors: Pietro Addeo, Issam Jedidi, Andrea Locicero, François Faitot, Constantin Oncioiu, Alina Onea, Philippe Bachellier

Published in: Journal of Gastrointestinal Surgery | Issue 9/2019

Login to get access

Abstract

Background

The prognostic value of tumor multinodularity in intrahepatic cholangiocarcinoma (ICC) remains debated. We aimed to evaluate the impact of tumor multinodularity according to the presence and distribution of multiples ICC’s nodules.

Methods

A retrospective review of a prospectively maintained database of patients undergoing resection for ICC from January 1995 to September 2017 was performed. Prognostic factors for survival were assessed by multivariate Cox analysis. Tumoral nodules were defined according to their number (single and multiple) and localization (satellites and contralateral).

Results

Out of 120 selected patients, 64 (53%) had single and 56 (47%) had multiple lesions. Multiple lesions included tumors with satellites (n = 40; 71.5%) and tumors with contralateral lesions (n = 16; 28.5%). Patients with multiple tumors had significantly larger mean main lesion size (p = 0.02), required a higher rate of perioperative transfusion (p = 0.04), had a greater rate of lymph node involvement (p < 0.0001), vascular invasion (p = 0.04), and poor differentiation (p = 0.04) than single tumors. Patients with single tumors experienced a 5-year survival significantly longer (40%) than patients with multiple tumors (14%; p = 0.004). Patients having tumors with satellites had inferior median overall survival and 5-year survival rates (20 months, 7%) compared with patients with contralateral tumors (33.6 months, 29%) (p = 0.09). Multivariable analysis identified tumor multinodularity, morbidity, tumor size < 5 cm, poor differentiation, and lymph node involvement as independent prognostic factors for overall survival.

Conclusions

Tumor multinodularity represents an independent risk factor for survival in ICCs and identifies a category of patients in need of more effective perioperative treatment.
Literature
1.
Bridgewater J, Galle PR, Khan SA, et al. Guidelines for the diagnosis and management of intrahepatic cholangiocarcinoma. J Hepatol 2014;60:1268–89.CrossRefPubMed
2.
Endo I, Gonen M, Yopp AC, et al. Intrahepatic cholangiocarcinoma: rising frequency, improved survival, and determinants of outcome after resection. Ann Surg 2008;248:84–96.CrossRefPubMed
3.
Spolverato G, Bagante F, Weiss M, et al. Comparative performances of the 7th and the 8th editions of the American Joint Committee on Cancer staging systems for intrahepatic cholangiocarcinoma. J Surg Oncol 2017;115:696–703.CrossRefPubMed
4.
de Jong MC, Nathan H, Sotiropoulos GC, et al. Intrahepatic cholangiocarcinoma: an international multi-institutional analysis of prognostic factors and lymph node assessment. J Clin Oncol 2011;29:3140–5.CrossRefPubMed
5.
Hyder O, Marques H, Pulitano C, et al. A nomogram to predict long-term survival after resection for intrahepatic cholangiocarcinoma: an Eastern and Western experience. JAMA Surg 2014;149:432–8.CrossRefPubMed
6.
Ribero D, Pinna AD, Guglielmi A, et al. Surgical Approach for Long-term Survival of Patients With Intrahepatic Cholangiocarcinoma: A Multi-institutional Analysis of 434 Patients. Arch Surg 2012;147:1107–13.CrossRefPubMed
7.
Wright GP, Perkins S, Jones H, et al. Surgical Resection Does Not Improve Survival in Multifocal Intrahepatic Cholangiocarcinoma: A Comparison of Surgical Resection with Intra-Arterial Therapies. Ann Surg Oncol 2018;25:83–90.CrossRefPubMed
8.
Farges O, Fuks D, Boleslawski E, et al. Influence of surgical margins on outcome in patients with intrahepatic cholangiocarcinoma: a multicenter study by the AFC-IHCC-2009 study group. Ann Surg 2011;254:824–29; discussion 30.CrossRefPubMed
9.
Conci S, Ruzzenente A, Vigano L, et al. Patterns of Distribution of Hepatic Nodules (Single, Satellites or Multifocal) in Intrahepatic Cholangiocarcinoma: Prognostic Impact After Surgery. Ann Surg Oncol 2018.
10.
Spolverato G, Kim Y, Alexandrescu S, et al. Is Hepatic Resection for Large or Multifocal Intrahepatic Cholangiocarcinoma Justified? Results from a Multi-Institutional Collaboration. Ann Surg Oncol 2015;22:2218–25.CrossRefPubMed
11.
Souche R, Addeo P, Oussoultzoglou E, et al. First and repeat liver resection for primary and recurrent intrahepatic cholangiocarcinoma. Am J Surg 2016;212:221–9.CrossRefPubMed
12.
Le Roy B, Gelli M, Pittau G, et al. Neoadjuvant chemotherapy for initially unresectable intrahepatic cholangiocarcinoma. Br J Surg 2017.
13.
Sasaki K, Margonis GA, Andreatos N, et al. Preoperative Risk Score and Prediction of Long-Term Outcomes after Hepatectomy for Intrahepatic Cholangiocarcinoma. J Am Coll Surg 2017.
14.
Bergeat D, Sulpice L, Rayar M, et al. Extended liver resections for intrahepatic cholangiocarcinoma: friend or foe?. Surgery 2015;157:656–65.CrossRefPubMed
15.
Shimada K, Sano T, Nara S, et al. Therapeutic value of lymph node dissection during hepatectomy in patients with intrahepatic cholangiocellular carcinoma with negative lymph node involvement. Surgery 2009;145:411–6.CrossRefPubMed
16.
Shirabe K, Mano Y, Taketomi A, et al. Clinicopathological prognostic factors after hepatectomy for patients with mass-forming type intrahepatic cholangiocarcinoma: relevance of the lymphatic invasion index. Ann Surg Oncol 2010;17:1816–22.CrossRefPubMed
17.
Bagante F, Spolverato G, Weiss M, et al. Defining Long-Term Survivors Following Resection of Intrahepatic Cholangiocarcinoma. J Gastrointest Surg 2017;21:1888–97.CrossRefPubMed
18.
Valle J, Wasan H, Palmer DH, et al. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med 2010;362:1273–81.CrossRefPubMed
19.
Rayar M, Sulpice L, Edeline J, et al. Intra-arterial yttrium-90 radioembolization combined with systemic chemotherapy is a promising method for downstaging unresectable huge intrahepatic cholangiocarcinoma to surgical treatment. Ann Surg Oncol 2015;22:3102–8.CrossRefPubMed
20.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205–13.CrossRefPubMedPubMedCentral
21.
Balzan S, Belghiti J, Farges O, et al. The “50-50 criteria” on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg 2005;242:824–8, discussion 8-9.CrossRefPubMedPubMedCentral
22.
Koch M, Garden OJ, Padbury R, et al. Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery 2011;149:680–8.CrossRefPubMed
23.
Giraudo G, Greget M, Oussoultzoglou E, Rosso E, Bachellier P, Jaeck D. Preoperative contralateral portal vein embolization before major hepatic resection is a safe and efficient procedure: a large single institution experience. Surgery 2008;143:476–82.CrossRefPubMed
24.
Farges O, Fuks D, Le Treut YP, et al. AJCC 7th edition of TNM staging accurately discriminates outcomes of patients with resectable intrahepatic cholangiocarcinoma: By the AFC-IHCC-2009 study group. Cancer 2011;117:2170–7.CrossRefPubMed
25.
Spolverato G, Ejaz A, Kim Y, et al. Tumor size predicts vascular invasion and histologic grade among patients undergoing resection of intrahepatic cholangiocarcinoma. J Gastrointest Surg 2014;18:1284–91.CrossRefPubMed
26.
Spolverato G, Yakoob MY, Kim Y, et al. Impact of complications on long-term survival after resection of intrahepatic cholangiocarcinoma. Cancer 2015;121:2730–9.CrossRefPubMed
27.
Doussot A, Lim C, Gomez-Gavara C, et al. Multicentre study of the impact of morbidity on long-term survival following hepatectomy for intrahepatic cholangiocarcinoma. Br J Surg 2016;103:1887–94.CrossRefPubMed
28.
Sur MD, In H, Sharpe SM, et al. Defining the Benefit of Adjuvant Therapy Following Resection for Intrahepatic Cholangiocarcinoma. Ann Surg Oncol 2015;22:2209–17.CrossRefPubMed
Metadata
Title
Prognostic Impact of Tumor Multinodularity in Intrahepatic Cholangiocarcinoma
Authors
Pietro Addeo
Issam Jedidi
Andrea Locicero
François Faitot
Constantin Oncioiu
Alina Onea
Philippe Bachellier
Publication date
01-09-2019
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 9/2019
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-018-4052-y

Other articles of this Issue 9/2019

Journal of Gastrointestinal Surgery 9/2019 Go to the issue

Review Article

Optimising Surgical Technique in Laparoscopic Cholecystectomy: a Review of Intraoperative Interventions

Original Article

The Role of Continuing Perioperative Chemotherapy Post Surgery in Patients with Esophageal or Gastroesophageal Junction Adenocarcinoma: a Multicenter Cohort Study

Original Article

CT Scan Findings Can Predict the Safety of Delayed Appendectomy for Acute Appendicitis

Original Article

Cholecystectomy Risk in Crohn’s Disease Patients After Ileal Resection: a Long-term Nationwide Cohort Study

Original Article

Do Stage I Colorectal Cancers with Lymphatic Invasion Require a Different Postoperative Approach?

Original Article

Postoperative Pancreatic Fistula Following Pancreaticoduodenectomy—Stratification of Patient Risk