To better guide the diagnosis and treatment of intrahepatic cholangiocarcinoma (ICC) and improve the survival of ICC patients, the cholangiocarcinoma cooperation group of Professional Committee of Liver Cancer of China Anti-Cancer Association, Academician Fan Jia serving as the Chairman of the editorial board, integrated with the latest evidence in clinical practice and drafted the Chinese Expert Consensus on Diagnosis and Treatment of Intrahepatic Cholangiocarcinoma of Guideline on Diagnosis and Treatment of Primary Liver Cancer (2022 edition). This expert consensus focuses upon the screening and diagnosis, pathological diagnosis and molecular typing, multi-disciplinary comprehensive diagnosis and treatment, surgical, local and systematic treatment of ICC, aiming to enhance the clinicians' capability for the diagnosis and treatment of ICC and bring the most benefits to ICC patients.
Clinical research results of three studies from the international multi-center trial on surgical resection of ICC, jointly conducted by the team of Professor Lyu Yi and Professor Zhang Xufeng from the First Affiliated Hospital of Xi’an Jiaotong University (XJTU) and 15 affiliated hospitals of universities (centers) in North America, Europe, Asia and Oceania, were adopted and cited by expert consensus in this guideline.
Original text cited as:
Surgical treatment of ICC: major hepatectomy can not significantly improve clinical prognosis of ICC patients, but also increase the incidence of postoperative complications. The results of a multi-center propensity score matching study enrolling 1023 ICC patients found that there is no significant difference in the survival benefits between patients undergoing major and minor hepatectomy [77]. Margin width, rather than the extent of resection, affects long-term outcomes. Radical parenchymal-sparing resection should be advocated if a margin clearance of ≥5 mm can be achieved [77].
Lymphadenectomy: The findings of an international multi-center trial indicated that standard lymphadenectomy of at least 6 lymph nodes is strongly recommended and should include examination beyond station 12, which can increase the positive lymph node detection rate, thus better guiding clinical prognosis [88]. Recent studies at home and abroad demonstrated that the proportion of ICC patients undergoing lymph node dissection has been increasing year by year, whereas a large number of patients who have not undergone lymph node dissection remain in the Nx lymph nodal staging [90]. Improving the awareness of the importance of ICC lymph node dissection and accurate clinical diagnosis are the keys to increase the proportion of ICC patients undergoing lymph node dissection.
References cited as:
77．Zhang XF, Bagante F, Chakedis J, et al. Perioperative and long-term outcome for intrahepatic cholangiocarcinoma: impact of major versus minor hepatectomy[J]. J Gastrointest Surg,2017,21(11):1841-1850. DOI:10.1007/s11605-017-3499-6.
88．Zhang XF, Xue F, Dong DH, et al. Number and station of lymph node metastasis after curative-intent resection of intrahepatic cholangiocarcinoma impact prognosis[J]. Ann Surg,2021,274(6):e1187-e1195. DOI:10.1097/SLA.0000000000003788.
90. Zhang XF, Chakedis J, Bagante F, et al. Trends in use of lymphadenectomy in surgery with curative intent for intrahepatic cholangiocarcinoma[J]. Br J Surg, 2018, 105(7):857-866. DOI:10.1002/bjs.10827.
In recent years, Professor Lyu Yi and Professor Zhang Xufeng have cooperated with multipleprestigious international centers to carry out clinical trials related to ICC. The following representative research results have been proposed: standard lymph node dissection is advocated during ICC resection.The scope of lymph node dissection should exceed station 12 and the number of lymph nodes should be ≥6. According to the number of positive lymph nodes, new nodal staging of N0 (no lymph node metastasis), N1 (1-2 lymph node metastases) and N2 (≥3 lymph node metastases) should be further defined, etc. A series of research results provide significant evidence-based data for the revision of Chinese and international guidelines, which will further standardize clinical diagnosis and treatment of ICC and enhance overall prognosis of ICC patients.
