Patterns of Recurrence after Resection of Mass-Forming Type Intrahepatic Cholangiocarcinomas

  • Luvira, Vor (Department of Surgery, Faculty of Medicine, Khon Kaen University) ;
  • Eurboonyanun, Chalerm (Department of Surgery, Faculty of Medicine, Khon Kaen University) ;
  • Bhudhisawasdi, Vajarabhongsa (Department of Surgery, Faculty of Medicine, Khon Kaen University) ;
  • Pugkhem, Ake (Department of Surgery, Faculty of Medicine, Khon Kaen University) ;
  • Pairojkul, Chawalit (Department of Pathology, Faculty of Medicine, Khon Kaen University) ;
  • Luvira, Varisara (Department of Community Medicine, Faculty of Medicine, Khon Kaen University) ;
  • Sathitkarnmanee, Egapong (Department of Surgery, Faculty of Medicine, Khon Kaen University) ;
  • Somsap, Kulyada (Department of Radiology, Faculty of Medicine, Khon Kaen University) ;
  • Kamsa-ard, Supot (Cancer Unit, Srinagarind Hospital, Khon Kaen University)
  • Published : 2016.10.01


Background: Intrahepatic cholangiocarcinoma (IHCCA) is an aggressive tumor for which surgical resection is a mainstay of treatment. However, recurrence after resection is common associated with a poor prognosis. Studies regarding recurrence of mass-forming IHCCA are rare; therefore, we investigated the pattern with our dataset. Methods: We retrospectively reviewed the medical and pathological records of 50 mass-forming IHCCA patients who underwent hepatic resection between January 2004 and December 2009 in order to determine the patterns of recurrence and prognosis. All demographic and operative parameters were analyzed for their effects on recurrence-free survival. Results: The median recurrence-free survival time was 188 days (95%CI: 149-299). The respective 1-, 2-, and 3-year recurrence-free survival rates were 16.2% (95%CI: 6.6-29.4), 5.4% (95%CI: 1.0-15.8) and 2.7% (95%CI: 0.2-12.0). There was an equal distribution of recurrence at solitary and multiple sites. Univariate analysis revealed no factors related to recurrence-free survival.Conclusion: The overall survival and recurrence-free survival after surgery for mass-forming IHCCA were found to be very poor. Almost all recurrences were detected within 2 years after surgery. Adjuvant chemotherapy after surgery may add benefit in the affected patients.


Mass forming intrahepatic cholangiocarcinoma;recurrence;survival;curative resection


Supported by : Khon Kaen University, Thailand (KKU)


  1. Aishima S, Oda Y (2015). Pathogenesis and classification of intrahepatic cholangiocarcinoma: different characters of perihilar large duct type versus peripheral small duct type. J Hepatobiliary Pancreat Sci, 22, 94-100.
  2. Bhudhisawasdi V, Khuntikeo N, Chur-in S, et al (2012). Cholangiocarcinoma: Experience of Srinagaraind Hospital. Srinagarind medical Journal, 27, 331-9.
  3. Bridgewater J, Galle PR, Khan SA, et al (2014). Guidelines for the diagnosis and management of intrahepatic cholangiocarcinoma. J Hepatol, 60,1268-89.
  4. De Jong MC, Nathan H, Sotiropoulos GC, et al (2011). Intrahepatic cholangiocarcinoma: an international multi-institutional analysis of prognostic factors and lymph node assessment. J Clin Oncol, 29, 3140-5.
  5. Endo I, Gonen M, Yopp AC, et al (2008). Intrahepatic cholangiocarcinoma: rising frequency, improved survival, and determinants of outcome after resection. Ann Surg, 248, 84-96.
  6. Hyder O, Hatzaras I, Sotiropoulos GC, et al (2013). Recurrence after operative management of intrahepatic cholangiocarcinoma. Surgery, 153, 811-8.
  7. Jung SJ, Woo SM, Park HK, et al (2012). Patterns of initial disease recurrence after resection of biliary tract cancer. Oncology, 83, 83-90.
  8. Khan SA, Taylor-Robinson SD, Toledano MB, et al (2002). Changing international trends in mortality rates for liver, biliary and pancreatic tumours. J Hepatol, 37, 806-13.
  9. Kim DH, Choi DW, Choi SH, et al (2015). Is there a role for systematic hepatic pedicle lymphadenectomy in intrahepatic cholangiocarcinoma? A review of 17 years of experience in a tertiary institution. Surgery, 157, 666-75.
  10. Konstantinidis IT, Arkadopoulos N, Ferrone CR (2016). Surgical management of intrahepatic cholangiocarcinoma in the modern era: advances and challenges. Chin Clin Oncol, 5, 9-15.
  11. Luvira V, Nilprapha K, Bhudhisawasdi V, et al (2002). Cholangiocarcinoma Patient Outcome in Northeastern Thailand: Single-Center Prospective Study. Asian Pac J Cancer Prev, 17, 401-6.
  12. Morine Y, Shimada M, Utsunomiya T, et al (2012). Clinical impact of lymph node dissection in surgery for peripheral-type intrahepatic cholangiocarcinoma. Surg Today, 42, 147-51.
  13. Morine Y, Shimada M (2015). The value of systematic lymph node dissection for intrahepatic cholangiocarcinoma from the viewpoint of liver lymphatics. J Gastroenterol, 50, 913-27.
  14. Nakanuma Y, Sato Y, Harada K, et al (2010). Pathological classification of intrahepatic cholangiocarcinoma based on a new concept. World J Hepatol, 2, 419-27.
  15. Ribero D, Pinna AD, Guglielmi A, et al (2012). Surgical Approach for Long-term Survival of Patients With Intrahepatic Cholangiocarcinoma: A Multi-institutional Analysis of 434 Patients. Arch Surg, 147, 1107-13.
  16. Spolverato G, Kim Y, Alexandrescu S, et al (2016). Management and Outcomes of Patients with Recurrent Intrahepatic Cholangiocarcinoma Following Previous Curative-Intent Surgical Resection. Ann Surg Oncol, 23, 235-43.
  17. Suzuki S, Sakaguchi T, Yokoi Y, et al (2002). Clinicopathological prognostic factors and impact of surgical treatment of massforming intrahepatic cholangiocarcinoma. World J Surg, 26, 687-93.
  18. Tan JCC, Coburn NG, Baxter NN, et al (2008). Surgical management of intrahepatic cholangiocarcinoma-a population-based study. Ann Surg Oncol, 15, 600-8.
  19. Weber SM, Jarnagin WR, Klimstra D, et al (2001). Intrahepatic cholangiocarcinoma: resectability, recurrence pattern, and outcomes. J Am Coll Surg, 193, 384-91.
  20. Wirasorn K, Ngamprasertchai T, Khuntikeo N, et al (2013). Adjuvant chemotherapy in resectable cholangiocarcinoma patients. J Gastroenterol Hepatol, 28, 1885-91.
  21. Wu ZF, Wu XY, Zhu N, et al (2015). Prognosis after resection for hepatitis B virus-associated intrahepatic cholangiocarcinoma. World J Gastroenterol, 21, 935-43.
  22. Yamamoto J, Kosuge T, Shimada K, et al (1993). Intrahepatic cholangiocarcinoma: proposal of new macroscopic classification. Nihon Geka Gakkai Zasshi, 94, 1194-200.
  23. Yamamoto M, Ariizumi S (2006). Intrahepatic recurrence after surgery in patients with intrahepatic cholangiocarcinoma. J Gastroenterol, 41, 925-6.