Supplementary Material for: Surgery for multifocal intrahepatic cholangiocarcinoma

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.