Liver resection may represent the only hope of cure for patients with
intrahepatic cholangiocarcinoma (IHC) but long-term results are still far from satisfactory and the impact of prognostic factors is still controversial. Fifty-five patients underwent
hepatectomy for IHC between 1997 and 2008 in our unit. Features of the patients and the
tumors, operations, postoperative and long-term results were retrospectively assessed. Twenty-one patients had HBV/HCV
infection, four had
congenital biliary dilatation. Thirty-two patients had increased CA 19-9; 12 had multiple (≥ 4)
tumors. Operations included 43 major resections, with 9 resections of biliary confluence, 40 regional
lymphadenectomies. Operative mortality and morbidity were 0 and 27.3%, respectively. There were 44 R0-resections (80.0%).
Lymphadenectomy yielded
lymph node metastases in 14 cases (14/40; 35.0%). Five-year overall and disease-free survival rates were 30.2 and 27.5%, respectively. At multivariate analysis the strongest poor prognostic factor for overall survival was
tumor stage. This factor, with multiplicity of lesions (≥ 4) and
tumor grading > 2, was significant predictor of recurrence. CA19-9 > 100 IU/mL and
tumor grading > 2 were found to be significantly related with early multinodular hepatic recurrence. Patients with
lymph node metastases had significantly lower overall and disease-free survival but patients who underwent
lymph node dissection with negative lymph nodes at final pathology showed significantly higher 5-year disease-free survival than patients who did not underwent
lymphadenectomy. In conclusion, these results support the role of
hepatectomy with regional
lymphadenectomy as the best available treatment for IHC. Prognosis after liver resection correlates with clinical stage and multiplicity of lesions.