Vascular resection and reconstruction in surgery for advanced intrahepatic cholangiocarcinoma : single center experience with 59 vascular resections

Abstract

Major vascular involvement in intrahepatic cholangiocarcinoma (iCCA) is often considered a relative contraindication to resection, resulting in limited data on hepatectomy with vascular resection and reconstruction. This study aimed to assess perioperative and long-term outcomes of hepatectomy combined with vascular resection and reconstruction in a high volume single center. We retrospectively analyzed all patients undergoing surgical exploration for iCCA between 2008 and 2023, with follow-up through January 2025. Data were evaluated for vascular resections involving the portal vein, major hepatic veins, or inferior vena cava, and their impact on outcomes. Among 345 explored patients, 265 (77 %) underwent resection with curative intent; 41 (16 %) required 59 vascular resections with reconstruction. Factors significantly associated with vascular resection included extent of hepatectomy, nodal status, tumor grading, and UICC stage. Vascular invasion was confirmed histologically in 37 % of resected vessels. Ninety-day mortality was higher in the vascular resection group (15 % vs. 6 %), with biliary reconstruction identified as a key mortality risk factor. Median overall survival was 17 months for vascular resection patients versus 25 months without. Recurrence-free survival was similar between groups. Within the vascular resection group, macrovascular invasion was associated with worse survival (11 vs. 25 months). The 5-year survival rate was 20 %, exceeding outcomes of palliative treatment. As only one-third of vascular resections showed confirmed macrovascular invasion, suspected vascular involvement should not be an absolute contraindication to resection. Nonetheless, caution is adviced when hepaticojejunostomy is required. Further studies are needed to assess outcomes following neoadjuvant therapy.