Background Multifocal intrahepatic cholangiocarcinoma (m-ICC) is an aggressive form of primary liver cancer, often associated with poor outcomes. Although surgical resection is considered the only curative treatment for ICC, multifocality is frequently regarded as a contraindication due to the high risk of recurrence and limited survival benefits. Aim To perform a systematic literature review on the outcomes of surgical treatment of m-iCCA. Methods This systematic review was performed according to PRISMA statement. A study protocol for the review was registered in the International Prospective Register of Systematic Reviews database. Databases were systematically searched for studies analysing surgical treatment outcomes for m-iCCA. Results Ten articles with 2392 patients who had m-ICCA were included in our review. The reviewed studies reported extensive surgical procedures with median survival ranging from 18.9 to 27 months. Recurrence rates were higher in m-iCCA patients (67.8–74.3%) compared to solitary ICC cases (52.4–60.5%), with recurrence-free survival as short as 4.5 months. One study reported a 5-year survival rate of 12.9% for surgical patients compared to 0% for non-operated patients. Survival outcomes were influenced by adverse prognostic indicators. Conclusions Surgical resection for multifocal intrahepatic cholangiocarcinoma is a challenging treatment option due to the high likelihood of recurrence and the aggressive nature of the disease. Despite these challenges, surgery may offer survival benefits for carefully selected patients.
Andzelytė et al. (2025) studied this question.