Surgery, Gastroenterology and Oncology

Mass-forming cholangiocarcinoma (MFCCC) is a disease at increasing incidence (1,2). Liver resection (LR) is the standard treatment, while chemotherapy has a limited effectiveness (3,4).
Five-year survival rates after complete surgery range between 20 and 35% (5-9). Although surgery represents the unique curative treatment, the disease is characterized by low resectability and high post-surgical recurrences rates (1-4). To date, resectability is based on morphological features (number and size of lesions, vascular invasion), lymphnode metastases (N stage), and surgical radicality (5-12).
If the surgical technique could play a role in improving resectability, molecular markers rather than gross tumor features could aid in defining and clarifying further prognostic predictors helpful to better select and manage the patients accordingly. On a technical standpoint, the margin width, if negative, does not impact the outcome, while a positive margin (< 1 mm, R1 resection) is associated with higher local recurrence rate and worse survival (8-15).

However, our group disclosed subcategories of R1 with a different prognostic impact in the event of surgery for colorectal liver metastases, which allowed to increase their resectability (16-17). Whether these subcategories play a role for other liver tumors is still matter of debate. Prognosis prediction is of paramount relevance for patients management either for their selection, and for the therapeutic and follow up strategies.
Reliable molecular markers for MFCCC are still lacking as well as an adequate assessment of tumor biology. The analysis of lymphoid infiltrate (LI) may work in this direction. The oncologic impact of LI has been analyzed in several tumors.

The largest evidences concern colorectal cancers (18-23). Focusing on liver tumors, some data have been reported for HCC and colorectal liver metastases (24-32), while no prior study focused on MFCCC. These two aspects will be discussed in this review article.

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