Surgical management of intrahepatic cholangiocarcinoma and combined hepatocellular-cholangiocarcinoma: a narrative review of principles, technical nuances, and emerging strategies
- Author:
Woohyung LEE
1
;
Kwang Pyo HONG
;
Jae Hoon LEE
;
Mirang LEE
;
Minkyu SUNG
;
Seung Jae LEE
;
Ki Byung SONG
;
Dae Wook HWANG
;
Song Cheol KIM
Author Information
- Publication Type:Review Article
- From:Journal of Liver Cancer 2026;26(1):19-28
- CountryRepublic of Korea
- Language:English
- Abstract: Intrahepatic cholangiocarcinoma (CCA) is the second most common primary liver cancer after hepatocellular carcinoma (HCC). However, combined HCC-CCA is a rare malignancy exhibiting hepatocytic and cholangiocytic differentiation. For both tumors, R0 resection with regional lymph node dissection remains the only potentially curative treatment. Nevertheless, key aspects of surgical management remain controversial. In this narrative review, we synthesize contemporary evidence on the surgical management of intrahepatic CCA and combined HCC-CCA. We summarize current data on lymphadenectomy, safety, and oncologic comparability of minimally invasive vs. open surgery, and integration of liver hypertrophy techniques for major hepatectomy. We also review the emerging clinical experience with immune checkpoint inhibitor-based chemoimmunotherapy as a neoadjuvant treatment and conversion surgery for advanced disease. We highlight persisting knowledge gaps and propose practical perspectives to support individualized surgical planning for this heterogeneous disease.
