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Ruff et al. Hepatoma Res 2023;9:17 Hepatoma Research
DOI: 10.20517/2394-5079.2023.18

Review Open Access

Surgical management of intrahepatic

cholangiocarcinoma

Samantha M. Ruff, Timothy M. Pawlik
Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James
Comprehensive Cancer Center, Columbus 43210, OH, USA.

Correspondence to: Prof. Timothy M. Pawlik, Department of Surgery, The Ohio State University, Wexner Medical Center, 395
W. 12th Ave., Suite 670, Columbus 43210, OH, USA. E-mail: tim.pawlik@osumc.edu

How to cite this article: Ruff SM, Pawlik TM. Surgical management of intrahepatic cholangiocarcinoma. Hepatoma Res 2023;9:17.
https://dx.doi.org/10.20517/2394-5079.2023.18

Received: 14 Mar 2023 First Decision: 18 Apr 2023 Revised: 23 Apr 2023 Accepted: 8 May 2023 Published: 15 May 2023

Academic Editor: Georgios Tsoulfas Copy Editor: Yanbing Bai Production Editor: Yanbing Bai

Abstract
Intrahepatic cholangiocarcinoma (ICCA) is a rare tumor with a poor prognosis that arises from the intrahepatic
biliary tract. Patients who present with locally advanced or metastatic ICCA are generally treated with first-line
gemcitabine/cisplatin and/or liver-directed therapy with the hope of downstaging/downsizing the disease.
Patients who present with resectable ICCA may be treated with upfront surgery and postoperative adjuvant
capecitabine. Staging laparoscopy should be considered to evaluate for occult metastatic disease and laparoscopic
ultrasound can be used to better evaluate the liver parenchyma. Resection with the goal of achieving an R0 margin,
along with lymphadenectomy to adequately stage patients, should be the standard operative approach.
Unfortunately, the surgical technique cannot overcome poor tumor biology, and ICCA has a high incidence of
recurrence, with many patients developing metastatic disease. Targeted therapy with IDH and FGFR inhibitors has
had promising results in early clinical trials. Future endeavors should strive to identify more effective systemic and
targeted therapies, which will hopefully improve survival for patients with ICCA.

Keywords: Surgery, intrahepatic cholangiocarcinoma, margin status, lymphadenectomy

INTRODUCTION
Cholangiocarcinoma (CCA) is a rare tumor arising from the biliary tract that can be defined as either
intrahepatic (ICCA) or extrahepatic (ECCA) based on its anatomic location. ICCA arises from the biliary

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