Improving actual survival after hepatectomy for intrahepatic cholangiocarcinoma—still a long way to go

Complete resection stands as the only potentially curative treatment.Being often late diagnosed,vascular and biliary structures are frequently involved owing to centrally located and/or large lesions at the time of diagnosis.Consequently,complete resection can require complex hepatectomy often on diseased liver,associated with important risks of mortality and morbidity while benefits in terms of prolonged survival remain often uncertain.To date,only one large series investigating actual long-term survival after curative-intent hepatectomy reported an actual 5-year OS of 13%(1).Indeed,around two thirds of patients experience recurrence,mostly to the liver,and eventually die of disease recurrence(2).These observations suggest first that patient selection for resection might be inadequate.Second,surgery alone seems not able to provide sufficient disease control.For instance,recurrence is frequently observed even with early tumours classified AJCC 8th Edition stage IA disease resulting in an estimated 5-year disease specific survival nearing 60%only.