Surgery for Multifocal Intrahepatic Cholangiocarcinoma.

Introduction: Multifocal intrahepatic cholangiocarcinoma (m-iCCA) is a complex and aggressive form of primary liver cancer, often associated with poor outcomes. Although surgical resection is considered the only curative treatment for intrahepatic cholangiocarcinoma (iCCA), multifocality is frequently regarded as a contraindication due to the high risk of recurrence and limited survival benefits. Advances in surgical techniques and evolving treatment strategies have reopened discussions about the feasibility of resection in these cases.

Methods: We conducted this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A study protocol for the review was registered in the International Prospective Register of Systematic Reviews database. We systematically searched PubMed, Web of Science, MEDLINE, and ScienceDirect databases up to July 30, 2024, for studies analyzing surgical treatment outcomes for m-iCCA. We assessed the quality of the included studies according to the Newcastle-Ottawa Scale (NOS).

Results: After our initial search, 2,482 articles were found related to this topic and 381 articles were left for screening. We checked each article against the eligibility criteria and selected for the full-text analysis. Ten articles with 2,392 patients who had m-iCCA were included in our review. The reviewed studies reported extensive surgical procedures, such as extended hemihepatectomy and associating liver partition and portal vein ligation for staged hepatectomy, with median survival ranging from 18.9 to 27 months. Recurrence rates were higher in m-iCCA patients (67.8-74.3%) compared to solitary iCCA cases (52.4-60.5%), with recurrence-free survival as short as 4.5 months. Adjuvant chemotherapy was frequently used, although its effectiveness in terms of survival was inconsistent. One study reported a 5-year survival rate of 12.9% for surgical patients compared to 0% for non-operated patients. Survival outcomes were influenced by adverse prognostic indicators such as lymph node metastases and perineural invasion.

Conclusion: Surgical resection for m-iCCA, while associated with high recurrence rates (67.8-74.3%), provides a survival advantage over nonsurgical management (median overall survival: 18.9-27 months vs. 8 months; 5-year survival: 12.9% vs. 0%) for carefully selected patients. More studies are needed to improve patient selection and refine treatment approaches to enhance long-term outcomes.