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Impact of Anatomical Versus Non-anatomical Liver Resection on Short- and Long-Term Outcomes for Patients with Intrahepatic Cholangiocarcinoma

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Objective

The aim of this study was to examine the impact of anatomical resection (AR) versus non-anatomical resection (NAR) on the survival outcomes in patients with intrahepatic cholangiocarcinoma (ICC).

Patients and Methods

Data on 702 consecutive patients who underwent either AR (n = 319) or NAR (n = 383) for ICC were reviewed. Disease-free survival (DFS) and overall survival (OS) following AR versus NAR was compared using propensity score matching (PSM). Subgroups of patients who benefited from AR versus NAR were examined after being stratified by the 8th TNM staging of ICC.

Results

AR and NAR had similar complication rates (26.6% vs. 25.1%, p = 0.634). AR was associated with better 1-, 3-, and 5-year DFS and OS rates compared with NAR after PSM (58.1%, 35.7% and 28.1% vs. 44.1%, 23.9% and 18.0%; 72.9%, 45.7% and 36.0% vs. 62.0%, 30.8% and 25.3%; both p = 0.002). On multivariate analysis, NAR was associated with worse DFS and OS than AR [hazard ratio (HR) 1.461 and 1.488; 95% confidence interval (CI) 1.184–1.804 and 1.189–1.863, respectively]. Stratified analysis demonstrated similar outcomes following AR versus NAR for ICC at stages IA, II with vascular invasion, and III with visceral peritoneum perforation, local extrahepatic invasion and nodal metastasis, while NAR was associated with worse DFS and OS versus AR for stages IB (HR 1.897 and 2.321; 95% CI 1.179–3.052 and 1.376–3.914, respectively) or II ICC without vascular invasion (2.071 and 2.077; 95% CI 1.239–3.462 and 1.205–3.579, respectively).

Conclusions

AR was associated with better survival outcomes compared with NAR in ICC patients with stage IB or II tumors without vascular invasion.

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Acknowledgment

The authors would like to thank Drs. Lehua Shi and Zheng Li for their assistance with the data collection.

Funding

This study was supported by the State Key Project on Infectious Diseases of China (2012ZX10002-016), and the Creative Research Groups of the National Natural Science Foundation of China (30921006, 81521091).

Author information

Author notes

  1. Anfeng Si, Jun Li, and Zhishi Yang have contributed equally to this work.

Authors and Affiliations

  1. Department of Hepatic Surgery IV, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China

    Anfeng Si MD, Jun Li MD, Zhishi Yang MD, Yong Xia MD, Tian Yang MD, Zhengqing Lei MD, Zhangjun Cheng MD, Wan Yee Lau MD, FRCS, FACS, FRACS (Hon) & Feng Shen MD, PhD

  2. Department of Surgical Oncology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China

    Anfeng Si MD

  3. Department of Clinical Database, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China

    Yong Xia MD

  4. Department of General Surgery, Affiliated Zhongda Hospital, Southeast University, Nanjing, China

    Zhangjun Cheng MD

  5. Department of Surgery, Wexner Medical Center, Ohio State University, Columbus, OH, USA

    Timothy M. Pawlik MD, PhD, MPH

  6. Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong

    Wan Yee Lau MD, FRCS, FACS, FRACS (Hon)

Authors
  1. Anfeng Si MD
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  2. Jun Li MD
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  5. Tian Yang MD
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  8. Timothy M. Pawlik MD, PhD, MPH
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  9. Wan Yee Lau MD, FRCS, FACS, FRACS (Hon)
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  10. Feng Shen MD, PhD
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Contributions

FS had full access to all the data in the study and is responsible for the integrity of the data and accuracy of the data analyses. FS, AS, JL, ZY: study concept and design, and drafting of the manuscript. AS, JL, ZY, YX, TY, ZL: Collection and assembly of the data. FS, AS, JL, TY, ZC: data collection, analysis and interpretation. FS, TMP, WYL: critical revision of the manuscript for important intellectual content and administrative support. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Feng Shen MD, PhD.

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No potential conflicts of interest were disclosed.

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10434_2019_7260_MOESM7_ESM.pdf

DFS and OS rates after AR versus NAR for stage III ICC patients. (a) DFS rates in all stage III patients; (b) OS rates in all stage III patients; (c) DFS rates in stage IIIA patients without nodal metastasis; (d) OS rates in stage IIIA patients without nodal metastasis; (e) DFS rates in stage IIIB patients with nodal metastasis; (f) OS rates in stage IIIB patients with nodal metastasis. DFS disease-free survival, OS overall survival, AR anatomical resection, NAR non-anatomical resection, ICC intrahepatic cholangiocarcinoma (PDF 518 kb)

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Si, A., Li, J., Yang, Z. et al. Impact of Anatomical Versus Non-anatomical Liver Resection on Short- and Long-Term Outcomes for Patients with Intrahepatic Cholangiocarcinoma. Ann Surg Oncol 26, 1841–1850 (2019). https://doi.org/10.1245/s10434-019-07260-8

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  • DOI: https://doi.org/10.1245/s10434-019-07260-8

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