Prognostic Factors in Intrahepatic Cholangiocarcinoma - A Systematic Review

Introduction: intrahepatic cholangiocarcinoma (ICCA) are rare, aggressive cancers that develop in second order or smaller bile ducts. The aim of this review is to systematically review the most important prognostic factors affecting the long-term outcomes of these patients. Material and Methods: articles conducted on this issue, written in English, published between from January 2000 to December 2023 in Cochrane Library, PubMed, Embase, MedLine, Web of Science, Elsevier, Google Scholar were systematically researched and reviewed. Results: ICCA are usually late diagnosed cancers because of the asymptomatic character, and curative procedures are often not feasible, only 20 to 30% of patients being fit for surgery. With the prognostic of this aggressive malignancy being baleful, the most important risk factors but also prognosis factors seem to be represented by socioeconomic factors, morphological presentation, dimensions, number and extension of the tumor as well as resection margins. Conclusions: once these factors are widely recognized and identified in each case, the clinician will be able to find the best treatment for these patients in order to improve the long-term outcomes.

Intrahepatic Cholangiocarcinoma - Where Do We Stand Today? Literature Review

Intrahepatic cholangiocarcinomas represent rare and aggressive malignancies developing from the second order bile ducts to the smaller biliary branches. The aim of this narrative review is to discuss about the main diagnostic and therapeutic challenges in order to help medical and surgical oncologists to gain familiarity in regard to this subject. Articles discussing about epidemiology, histology, diagnostic, perioperative management and surgery which were published from January 2000 to September 2023 included in Cochrane Library, PubMed, Embase, MedLine, Web of Science, Elsevier, Google Scholar databases were reviewed. Articles reviewed in the current paper came to demonstrate that the main problem in such cases is related to the fact that most cases remain asymptomatic for a long period of time and therefore are diagnosed in advanced stages of the disease when curative procedures are feasible after performing extended visceral sacrifice or even worse, are no longer possible; however, the most efficient therapeutic strategy in order to improve the long term outcomes remains radical surgery. In this respect, attention was focused on improving the accuracy of the diagnostic tools and on identifying non-surgical therapeutic options which might increase the chances of achieving complete resection. Intrahepatic cholangiocarcinoma represent rare aggressive tumors with poor outcomes especially if radical surgery is not feasible.

Ultrasound-Guided Liver Resection of a Tumor Involving the Hepatocaval Confluence

We present the case of a 72-year-old patient with multiple cardiovascular comorbidities, hospitalized in our center for a liver tumor, impossible to biopsy percutaneously. CT examination detected a tumor formation with radiological features of cholangiocarcinoma, located in the upper part of segment I, extending to segments VII, VIII, IV superior and II, invading the right and middle hepatic vein, adherent to the left hepatic vein and to the retrohepatic inferior vena cava. Worth mentioning is the existence of 2 accessory lower right hepatic veins, which allowed us to perform a superior transverse non-anatomical ultrasound resection of the upper I, VII, VIII, IV and II segments, which also involved the right and middle hepatic veins, preserving the left hepatic vein, by detaching the tumor from it, but also from the retrohepatic inferior vena cava. Although the literature still debates the R1 vascular resection for cholangiocarcinoma, we decided to adopt this approach on the hepatic veins. Of note, we consider this policy not applicable for the portal pedicles. By adopting this strategy, the venous drainage of the remaining left hemiliver was ensured by the hepatic vein, and of the right one by the accessory veins. Although resecting tumors located at the hepato-caval confluence involving all hepatic veins is technically difficult, we consider it feasible especially when intraoperative ultrasound is used. (video article https://www.revistachirurgia.ro/pdfs/video/Ultrasound-Guided-Liver-Resection-Tumor-2282.mp4).