Oc.12.3 ex situ liver resection for intrahepatic cholangiocarcinoma: survival analysis and comparison to systemic chemotherapy

Surgical resection is the standard treatment for intrahepatic cholangiocarcinoma (iCCA). Systemic chemotherapy is the standard of care for patients not eligible for surgery. Ex situ liver resection is a surgical technique that could be an efficient treatment, increasing the number of patients eligible for surgery.This retrospective study aims to evaluate long-term outcomes in terms of overall survival (OS) and progression-free survival (PFS) and the related prognostic factors in patients affected by iCCA treated with ex situ resection or chemotherapy.Two populations of patients with iCCA, treated with surgical resection or chemotherapy were compared. OS and PFS were analyzed using survival analysis with the Kaplan-Meier estimator. OS was also analyzed using the Cox model. The non-parametric Log-rank test was used to evaluate the effect of individual covariates on survival. A total of 59 patients were included: 13 patients underwent ex situ resection and 46 patients were treated with chemotherapy. The surgical population had a survival benefit and a longer PFS compared to chemotherapy population: 1-year survival was 84.6% vs 52.2%, with a median OS of 46.1 vs 12.7 months and a median PFS of 23.08 vs 8.03 months, respectively. The other variables that influence patients’ survival were the stage of disease, patient's age, Ca19-9 level, and liver function. The stage of disease, the treatment, performance status (PS), Ca19-9 level, and liver function tests, were significant in Cox's regression analysis.Ex situ surgery seems to provide a longer survival and a lower progression probability compared to chemotherapy, even if it is technically challenging and burdened with high morbidity and mortality. Patients should be carefully selected, with good PS, low stage of disease, low Ca19-9 level, and good liver function. Ex situ surgery, deserves to be considered in high-volume hepatobiliary centers, with expertise in resective hepatic surgery and transplant surgery.