4.5 Article

Parenchyma-sparing hepatectomy improves salvageability and survival for solitary small intrahepatic cholangiocarcinoma

Journal

HPB
Volume 23, Issue 6, Pages 882-888

Publisher

ELSEVIER SCI LTD
DOI: 10.1016/j.hpb.2020.10.006

Keywords

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Funding

  1. Natural Science Foundation of China [81972747, 81872004, 81800564, 81770615, 81700555, 81672882]
  2. Science and Technology Support Program of Sichuan Province [2019YFQ0001, 2018SZ0115, 2017SZ0003]
  3. Science and Technology Program of Tibet Autonomous Region [XZ201801-GB-02]
  4. 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University [ZYJC18008]

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Parenchyma-sparing hepatectomy (PSH) for solitary small intrahepatic cholangiocarcinoma (ICC) patients reduces intraoperative blood loss and transfusion rate without increasing tumor recurrence, leading to improved overall survival.
Background: This study aimed to investigate the prognostic impact of parenchyma-sparing hepatectomy (PSH) on solitary small intrahepatic cholangiocarcinoma (ICC). Methods: A total of 184 patients with solitary small ICC (< 5 cm) from 2009 to 2017 were included. Short- and long-term outcomes were compared between PSH and Non-PSH approach. Results: 95 (51.6%) patients underwent PSH and 89 (48.4%) patients underwent Non-PSH for solitary small ICC. PSH was associated with less intraoperative blood loss (212.9 mL versus 363.5 mL, P=0.038), lower transfusion rate (7.4% versus 16.9%, P=0.048), without increasing the frequency of tumor recurrence (60.0% versus 58.4%). No significant differences were observed in overall survival (OS), recurrence-free survival (RFS) and liver RFS (P = 0.627, 0.769 and 0.538, respectively). 109 (59.2%) patients experienced recurrence, of these, 67 (36.4%) were intrahepatic recurrence. Subgroup analysis of patients with liver-only recurrence demonstrated an increased likelihood of repeat hepatectomy for PSH compared to Non-PSH (21.2% versus 2.9%, P = 0.031), thus resulting in improved liver OS (P = 0.016). Conclusion: PSH was associated with improved perioperative outcomes but it did not increase liver recurrence rates. PSH offered an increased rate of salvage hepatectomy for recurrent tumor, thus improving long-term survival in cases in which liver recurrence occurred.

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