Intention-to-treat curative liver resection in patients with “very early” intrahepatic cholangiocarcinoma

Introduction Intrahepatic cholangiocarcinoma (ICC) is a rare type of liver cancer. “Very early” ICC, defined as a solitary lesion of ≤ 2 cm in diameter, appears to have a favorable outcome. Purpose This study aimed to assess the outcome of patients with “very early” ICC treated with curative surgical resection in an intention-to-treat analysis. Methods All patients with ICC undergoing surgical resection at the Hospital Clínic of Barcelona (Spain) between April 2000 and December 2018 were reviewed, and those with evident “very early” ICC in preoperative imaging studies were selected. Results of histopathologic examination of the surgical specimen, postoperative complications, recurrence, and survival were assessed. Results Of the 89 patients operated for ICC during the study period, 7 (7.9%) met the “very early” criteria at preoperative imaging. Two (TNM 7th) and four (TNM 8th) patients were classified as stage I, following histological examination of their resected specimens. One patient presented with postoperative morbidity (grade II Clavien-Dindo). The median (IQR) hospital stay was 5 days (3–7). After a median follow-up of 23 months (IQR 11.9–80.6), recurrence was diagnosed in one case at 8.3 months after surgery. The overall survival at 1, 3, and 5 years was 85.7%, 68.6%, and 68.6%, respectively. Conclusion Intention-to-treat curative surgery in “very early” ICC is associated with good results in terms of survival and recurrence. However, most patients presented more advanced stages in the definitive pathological analysis, associated with a lower survival. Future prospective multicenter studies are required to validate these encouraging data.