Intrahepatic cholangiocarcinoma associated with the metabolic syndrome: characteristics and results of liver resection

Objective: To report short and long-term outcomes after hepatectomy for intrahepatic cholangiocarcinoma (ICC) related to metabolic syndrome (MS). Background: While the metabolic syndrome is being recognized as an important risk factor for ICC, MS-related ICC (MS+) remains poorly described. Methods: All patients undergoing hepatectomy for ICC between 2000-2016 at a single center were retrospectively analyzed. The peri-operative characteristics, pathological analysis and long-term outcomes of MS+ and ICC without MS (MS-) were compared. Results: Among 115 resected ICC patients, 40 (34.8%) were MS+ and 75 (65.2%) were MS-. MS+ patients were more frequently classified ASA>2 (37.5 vs. 5.3%, p=0.001) and exhibited increased Charlson comorbidity index (5±2 vs. 2±2, p< 0.001) than MS- patients. While operative characteristics did not differ significantly between the two groups, MS+ experienced higher rates of major complications (62.5 vs. 29.3%, p=0.001). On multivariate analysis, MS+ was an independent risk factor for both major complications (HR: 2.855, 95% CI: 1.072-7.599, p=0.036) and major cardiorespiratory complications (HR=4.356, 95% CI: 1.503-12.622, p=0.007). Pathological analysis revealed that MS+ displayed higher rates of non-alcoholic fatty liver disease (60.0 vs. 31.1%, p=0.003) and non-alcoholic steatohepatitis (25 vs. 5.4%, p=0.005) but significantly smaller lesions (64 vs. 76 mm, p=0.048). MS+ was independently associated with decreased risk of recurrence (HR: 0.462, 95% CI: 0.241-0.887, p=0.020). Conclusion: MS+ accounts for 35% of resected ICC patients. The prognosis of these patients seems to be more favorable but the existence of significant cardiovascular comorbidities increases postoperative morbidity and requires specific management.