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

Abstract

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