Intrahepatic cholangiocarcinoma: how do hepatectomy outcomes compare to liver metastases and hepatocellular carcinoma?

Laurence P Diggs; Alexander M Fagenson; Vijay Putatunda; Kwan Nang Lau; Miral S Grandhi; Henry A Pitt

doi:10.1016/j.hpb.2023.07.898

Intrahepatic cholangiocarcinoma: how do hepatectomy outcomes compare to liver metastases and hepatocellular carcinoma?

HPB (Oxford). 2023 Nov;25(11):1420-1428. doi: 10.1016/j.hpb.2023.07.898. Epub 2023 Jul 27.

Authors

Laurence P Diggs¹, Alexander M Fagenson², Vijay Putatunda¹, Kwan Nang Lau², Miral S Grandhi³, Henry A Pitt⁴

Affiliations

¹ Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA.
² Department of Surgery, Temple University Hospital, 3401NBroad Street, Philadelphia, PA, USA.
³ Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA; Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08901, USA.
⁴ Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA; Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08901, USA. Electronic address: Henry.Pitt@rwjbh.org.

PMID: 37573232
DOI: 10.1016/j.hpb.2023.07.898

Abstract

Background: The incidence of intrahepatic cholangiocarcinoma (ICC) continues to rise, and hepatectomy is the only cure. Perioperative outcomes following hepatectomy for colorectal liver metastases (CRLM) and hepatocellular carcinoma (HCC) are better described than for ICC. The aim was to compare post-hepatectomy outcomes for ICC to CRLM and HCC.

Methods: The 2014-2020 ACS NSQIP hepatectomy PUF was utilized. Patients with ICC, CRLM, and HCC were identified and others excluded. Demographic, disease, and procedural characteristics were collected. Univariable and multivariable analyses (Chi-Square for categorical variables; Kruskal-Wallis for continuous variables) were performed for mortality, serious morbidity, bile leak, post-hepatectomy liver failure (PHLF), and 30-day readmission.

Results: 17,789 patients underwent hepatectomy including 2377 for ICC, 10,195 for CRLM, and 5217 for HCC. Patients undergoing hepatectomy for ICC vs. HCC vs. CRLM were noted to have higher 30-day mortality (4.8% vs. 2.5% vs. 1.0%, respectively p < 0.05). ICC was associated with higher overall and serious morbidity, bile leak, severe PHLF, and readmission. Multivariable analyses confirmed higher odds ratios for mortality and morbidity (p < 0.05) in patients with ICC.

Conclusion: Hepatectomy for ICC is associated with worse short-term outcomes than for CRLM or HCC. Surgeons should be aware of these risks during surgical planning.