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Hou et al. Hepatoma Res 2023;9:35 https://dx.doi.org/10.20517/2394-5079.2023.40 Page 3 of 5

methods are expected to further the early identification of ICC.

ICC clinical staging system is not suitable for most cases of IHL-ICC. IHL-ICC is often mixed with
intrahepatic cholangitis, even liver abscesses, and inflammatory enlargement of lymph nodes. As a result, it
is difficult for clinical physicians to determine the actual size of the tumor and lymph node metastasis.
Strengthening follow-up procedures for all patients with IHL and ensuring early detection of intrahepatic
bile duct cancer are, therefore, of utmost importance.

Treatment of IHL-ICC
Surgical treatment
Radical resection surgery remains the primary treatment for IHL-ICC without distant metastasis. Complete
stone clearance and releasing biliary stricture can prevent the development of ICC. In cases where
intrahepatic lithiasis is concentrated in a specific liver lobe, such as frequently accumulating in the left
lateral lobe or right posterior lobe of the liver, local atrophy of the affected lobe may occur, necessitating the
resection of the entire lobe where the stones are located. Regional lymphadenectomy should be considered a
standard part of surgical therapy for patients undergoing radical resection surgery. Liver transplantation is
considered an optional treatment modality for early IHL-ICC without lymph node metastasis. However,
due to the scarcity of suitable liver donors and the frequent occurrence of peritoneal adhesions in patients
with IHL-ICC, liver transplantation surgery becomes challenging.

Adjuvant therapy after surgery
The recurrence rate of IHL-ICC following curative-intent surgery remains very high, which prompts a
much greater need to develop and support novel strategies for adjuvant chemo- and targeted agent
therapeutic trials. Like other types of ICC, adjuvant capecitabine, gemcitabine and oxaliplatin might be
[14]
beneficial for resected ICC patients, but this has not yet been confirmed by recent research .
After IHL-ICC surgery, preservation of liver function is also crucial. Administering drugs that protect
hepatocytes and promote bile secretion effectively improves liver function. In cases of biliary obstruction
caused by stone blockage or bile duct stenosis, choledochoscopy or percutaneous transhepatic biliary
drainage (PTCD) can be employed to relieve the obstruction and protect liver function. For patients with
biliary tract infections, in addition to successful bile drainage after obstruction removed, the administration
of antibiotics may be necessary for treatment.

Medical treatment for inoperable IHL-ICC patients
For unresectable IHL-ICC, besides the routine preservation of liver function, bile drainage, antibiotic
therapy, and traditional chemotherapy, molecular targeted therapy and immunotherapy guided by Next-
Generation Sequencing Solid Tumor are of paramount importance. IDH, FGFR, Immune Checkpoint
Inhibitors, and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) are the possible useful medicines for
the treatment of inoperable IHL-ICC .
[14]
CONCLUSION
Due to the heterogeneity of tumors, the clinical characteristics of IHL-ICC are different from those caused
by other etiologies. It is recommended to use artificial intelligence methods to early predict ICC for patients
with IHL. During the radical resection surgery, it is also necessary to remove intrahepatic stones as much as
possible to relieve bile duct stenosis. If the accumulation of stones leads to atrophy of the liver segment, the
liver segment should be removed. If possible, liver transplantation may be a more effective method for
treating early IHL-ICC without lymph node metastasis.