INTRODUCTION

Intrahepatic cholangiocarcinoma (iCCA) and combined hepatocellular-cholangiocarcinoma (cHCC-CCA) are uncommon primary liver malignancies for which surgical resection remains the only potentially curative treatment. In iCCA, R0 resection with appropriate regional lymph node dissection (LND) is widely regarded as the surgical standard. Conversely, cHCC-CCA is rare and pathologically heterogeneous, and preoperative diagnosis is often challenging, with many patients undergo resection based on an initial working diagnosis of hepatocellular carcinoma (HCC) or iCCA.

This narrative review summarizes current evidence regarding the surgical management of iCCA and cHCC-CCA. First, we outline the epidemiology, risk factors, and macroscopic subtypes of iCCA. Subsequently, we discuss the principles of liver resection, including the assessment and optimization of future liver remnant (FLR). Furthermore, we review the prognostic impact of lymph node metastasis, the ongoing debate over the extent of LND, the emerging role of indocyanine green-guided lymphatic mapping, and sentinel node concepts.

We also evaluate the expanding use of minimally invasive liver resection for iCCA, focusing on patient selection, technical feasibility, and oncologic comparability with open surgery. Additionally, we review early data on neoadjuvant chemoimmunotherapy for locally advanced CCA and summarize the current knowledge on the surgical management of cHCC-CCA.

EPIDEMIOLOGY AND RISK FACTORS

ICCA arises from the bile ducts, extending from the peripheral intrahepatic bile ducts to the second-order biliary confluence, and accounts for approximately 8-10% of all cholangiocarcinomas (CCAs).¹ The reported incidence ranges from 0.3 to 3.5 per 100,000 persons, with higher rates observed in East and Southeast Asia, including South Korea, China, Thailand, Japan, and Taiwan, than in Western countries.^2-4 The incidence is particularly high in the Gyeongnam Province and Jeju Island in South Korea.⁴

Temporal trends show a marked increase in the incidence of iCCA. In the United States, the age-standardized incidence rose from 0.8 to 1.9 per 100,000 between 2001 and 2017, representing an approximate 150% increase.^2,5 Earlier cancer registry data included perihilar CCA owing to limitations in International Classification of Diseases coding used until the early 2000s.⁶ Conversely, a previous study reported a modest decline in age-standardized rates from 8.8 to 7.8 per 100,000 between 2006 and 2015. A recent prediction model anticipated a gradual decrease in future incidence in South Korea.^7,8 Similar downward trends have also been reported in Thailand.⁹

Risk factors vary by geographic region. In Asia, hepatobiliary fluke infection, hepatolithiasis, and choledochal cysts are key etiologic factors. However, in Western countries, chronic hepatitis B or C and cirrhosis are major risk factors.⁵ More recently, diabetes, obesity, metabolic dysfunction-associated fatty liver disease, and persistent metabolic syndrome have emerged as relevant contributors to iCCA development.^5,10

MACROSCOPIC SUBTYPES AND TUMOR BIOLOGY

The macroscopic growth pattern of iCCA is closely linked to tumor biology and surgical strategy. The mass-forming type accounts for approximately 60-80% of cases and is thought to arise from peripheral small bile ducts or the canals of Hering. This subtype is often linked to chronic hepatitis, cirrhosis, and molecular alterations, including isocitrate dehydrogenase 1/2 and fibroblast growth factor receptor 2 fusions.^11-13 Mass-forming iCCA typically presents as a relatively large tumor with a high propensity for intrahepatic and hematogenous dissemination. Lymph node metastases are reported in 20-50% of patients, and major hepatectomy is frequently required owing to tumor size and location.

The periductal infiltrating type represents 15-30% of cases. These tumors extend longitudinally along the bile duct, are believed to originate from large bile ducts near the hepatic hilum, and commonly harbor KRAS, TP53, and SMAD4 mutations.^11,14,15 Their clinical behavior resembles that of perihilar CCA and is often associated with primary sclerosing cholangitis, intrahepatic duct stones, and liver fluke infection. Lymph node metastases occur in up to 60% of patients, and hilar involvement is frequent. Therefore, treatment often requires major hepatectomy combined with extrahepatic bile duct resection and Rouxen-Y hepaticojejunostomy. Given the close anatomical relationship between the bile ducts and major vessels of the hilum, vascular resection and reconstruction may be required. Nevertheless, achieving a negative margin in periductal-infiltrating and mass-forming plus periductal-infiltrating subtypes, achieving a negative margin remains challenging.^16,17

The intraductal growth type is the least common subtype, accounting for approximately 5-10% of iCCA cases. It is defined as an invasive cancer arising from intraductal papillary neoplasm of the bile duct and is characterized by papillary proliferation within the bile duct lumen.^12,18 Biologically, this subtype tends to exhibit less aggressive behavior, with a lower incidence of lymph node metastasis and vascular invasion than other types, resulting in a generally more favorable prognosis.^19,20

PRINCIPLES OF SURGICAL MANAGEMENT OF ICCA

Surgery is the only potentially curative treatment for iCCA. However, only 30-40% of cases are resectable at diagnosis. The 5-year overall survival rate is only 25-40%, even after resection.^21-24 The recurrence develops in 60-80% of patients within 2-5 years of R0 resection, most often in the liver (50-60%), followed by regional lymph nodes (20-30%) and distant sites such as the peritoneum and lungs. Early recurrence within 2 years is associated with multifocal tumors, lymph node metastasis, and vascular invasion.^21,24

The fundamental surgical goal in iCCA is R0 resection with the preservation of an adequate FLR and appropriate LND. Positive resection margins are associated with poor outcomes; with reported 5-year survival approaches 0%, and the risk of death is more than two-fold higher than that after R0 resection, irrespective of nodal status.²¹ Consistent with these findings, recent guidelines state that liver resection achieving an R0 margin is currently the only curative treatment for iCCA.²²

Following determination of surgical eligibility, preoperative cross-sectional imaging, including computed tomography or magnetic resonance imaging, with positron emission tomography-computed tomography, should be performed to exclude distant or para-aortic lymph node metastasis and assess R0 resection feasibility. Given that 49-78% of patients require major hepatectomy, careful assessment of FLR volume and function is essential.^22,23 In patients with normal liver parenchyma, an FLR of at least 30% of total liver volume is generally required, whereas a threshold of 40% is recommended in those with chronic liver disease, steatosis, or prior chemotherapy.²³ In cases of insufficient predicted FLR, several strategies can be employed to induce hypertrophy of the remnant liver before hepatectomy, with portal vein embolization (PVE) being the most widely adopted technique. PVE is typically followed by surgery after approximately 3 weeks, achieving a 30-50% increase in FLR.^25,26 However, up to 20% of patients fail to proceed to surgery because of tumor progression, development of distant metastases, or insufficient hypertrophy.²⁵ Liver venous deprivation (LVD), which combines PVE with hepatic vein embolization, has recently gained popularity. Notably, LVD induces FLR hypertrophy of approximately 60% within 1-3 weeks and has been associated with a lower dropout rate of 15%.^27-29 In a network meta-analysis comparing hypertrophy techniques, LVD increased FLR by a mean of 17.3% more than PVE and achieved superior FLR/body weight ratios compared with PVE or associated liver partition and portal vein ligation for staged hepatectomy (ALPPS). It was also associated with a lower rate of post-hepatectomy liver failure (odds ratio [OR], 0.35; 95% confidence interval [CI], 0.14-0.87) and reduced 90-day mortality.^27-29 However, LVD can cause perivascular inflammation, making hilar and hepatic vein dissection more challenging and potentially increasing bleeding and operative time. Moreover, the current evidence is largely based on a retrospective series, and further prospective studies are required. ALPPS induces rapid hypertrophy of 50-80% within 1-2 weeks, but is associated with high morbidity and mortality; therefore, it is generally not recommended when alternative hypertrophy strategies are feasible (Fig. 1).²⁷

LYMPH NODE METASTASIS AND LYMPHADENECTOMY

Lymph node metastasis is one of the most powerful prognostic factors of iCCA. Nodal metastases are detected in 17-62% of patients undergoing resection and in up to 70% at autopsy.^21,24,30 Nodal involvement confers an approximately two-fold increased risk of death compared with node-negative disease, and the American Joint Committee on Cancer 8th edition classifies N1 iCCA as stage IIIB.^24,31 Despite its prognostic significance, the role of routine LND in iCCA remains controversial. The opponents of systematic LND contend that nodal metastasis reflects disseminated systemic disease and cannot be cured by regional node clearance alone,^24,32 Additionally, given that hepatic lymphatic drainage is multidirectional, metastatic nodes may lie outside the standard dissection field, and extensive LND may not capture all involved stations. Furthermore, several retrospective studies have failed to demonstrate a survival benefit of LND in patients with established nodal metastasis and suggest no clear advantage in node-negative patients.^33-36 In contrast, proponents of LND emphasize several considerations. First, accurate pathological staging requires systematic LND; without it, many patients are understaged.^37,38 Second, tumors spread along the perivascular neural tissue may be amenable to clearance by LND. Third, even in clinical N0 patients, micrometastases may be present and can only be identified by pathological examination. Finally, preoperative imaging has a limited sensitivity of approximately 50-70% and a high false-negative rate for regional nodal disease, making the radiologic cN0 status unreliable.^32,38-40

Anatomical studies and clinical series have shown that the lymphatic drainage patterns of iCCA vary with tumor location.^30,41,42 Advances in near-infrared imaging and indocyanine green fluorescence have enabled the intraoperative visualization of hepatic lymphatics, and early prospective studies have examined indocyanine green (ICG)-guided mapping and sentinel lymph node concepts in iCCA. ICG-guided dissection has been associated with the retrieval of more nodes and a higher detection rate of positive nodes, but its diagnostic accuracy and optimal clinical role remain to be defined.^43-45

A Japanese single-center study from the Osaka Medical Center evaluated lymph node metastasis according to tumor size and location in 46 patients. Peripheral tumors ≤5 cm had no nodal metastasis, whereas hilar lesions had a 100% nodal involvement rate. The authors therefore suggested that LND might be omitted in selected patients with small peripheral tumors.⁴¹ In contrast, a Korean multicenter study of 121 patients found that although peripheral tumors had a significantly lower nodal metastasis rate than tumors near the second biliary confluence (21.9% vs. 46.1%, P=0.016), the 21.9% risk was still too high to justify omission of LND.⁴²

Current guidelines consider para-aortic or celiac nodal metastases as a distant disease and a contraindication to curative resection.^22,23 The recommended LND includes the removal of nodes along the common hepatic artery and hepatoduodenal ligament. For left-sided tumors, dissection may extend to the lesser curvature and cardia of the stomach. Based on multi-institutional analyses, the American Joint Committee on Cancer 8th edition recommends retrieval of at least six lymph nodes to achieve adequate staging.^46,47 Studies have shown that examining at least six nodes increases detection of nodal metastasis, improves N-stage discrimination, and is associated with better prognostic stratification.^46,47 However, 30-40% of patients in contemporary series still undergo resection without LND, reflecting ongoing selection bias and lack of consensus.^34-36 Further prospective and high-quality retrospective studies are needed to refine the indications for, and extent of, LND acceptable to the broader surgical community.

MINIMALLY INVASIVE SURGERY FOR ICCA

Since 2007, rapid advances in surgical instruments and accumulated experience have expanded the indications for minimally invasive liver surgery (MILS).⁴⁸ Current consensus classifies wedge resection or segmentectomy of the anterolateral segments (II, III, IVb, V, VI) and left lateral sectionectomy as standard procedures. In contrast, hemihepatectomy, right posterior sectionectomy, and trisectionectomy are advanced operations suitable only for high-volume centers with experienced teams. Hepatectomy of the posterosuperior segments (I, IVa, VII, VIII) is also regarded as major liver resection.^49-52 Previous studies show that laparoscopic liver resection (LLR) offers several advantages over open surgery, including reduced blood loss, transfusion and complication rates, and shorter hospital stay, while maintaining comparable oncologic outcomes in selected patients.⁵³ Robotic liver resection has emerged as another MILS platform, providing articulated instruments and a magnified three-dimensional view that enhances dexterity and visualization. Recent data suggest that in technically demanding locations, robotic surgery may reduce blood loss and conversion rates compared to laparoscopy.^54,55 Indications for MILS have progressively expanded from benign diseases to HCC, colorectal liver metastases, iCCA, and perihilar CCA in highly specialized centers.^50,56 Several considerations are specific to minimally invasive surgery (MIS) for iCCA. Surgeons should be proficient in laparoscopic or robotic LND along the common hepatic artery and hepatoduodenal ligament, as well as in performing major hepatectomy to achieve the guideline-driven extent of resection.²² However, the 2018 Southampton consensus guidelines did not recommend LLR for iCCA, primarily because of concerns regarding the technical complexity of performing an oncologically sound LND.⁴⁹ Increased experience with laparoscopic pancreaticoduodenectomy and MIS for gallbladder cancer has improved surgeons’ familiarity with LND, with recent studies showing comparable lymph nodes retrieval between open and laparoscopic procedures.^57-59 Furthermore, the robotic platform provides a stable, high-definition three-dimensional view and wristed instruments, enabling meticulous dissection and safe control of major vascular structures.^60,61 Case series of laparoscopic procedures for iCCA have been reported since 2015, describing less blood loss and comparable perioperative and oncologic outcomes in the laparoscopic group.^62,63 A recent meta-analysis⁶⁴ including six propensity score-matched studies comparing LLR and open liver resection for iCCA evidenced significantly less blood loss in the laparoscopic group (mean difference, -161 mL; 95% CI, -237 to -86), lower intraoperative transfusion rates (OR, 0.41; 95% CI, 0.26-0.69), shorter hospital stay (-3.16 days; 95% CI, -4.98 to -1.34), and fewer severe complications (Clavien-Dindo≥III; OR, 0.60; 95% CI, 0.39-0.93). These findings indicate that the general advantages of MILS also apply to iCCA.^65-67

With regard to LND, a 2023 systematic review of 17 studies reported that LND was performed less frequently in LLR than in open surgery (OR, 0.44; 95% CI, 0.23-0.82; P=0.01), highlighting ongoing selection and technical limitations.⁶⁸ The introduction of robotic surgery may help overcome some of these barriers. Although experience with robotic liver resection for iCCA remains limited, recent comparative studies have shown similar rates of LND between the robotic and open groups (47.2% vs. 55.3%, P=0.18) and comparable numbers of retrieved nodes (3.5 vs. 4.0, P=0.75), suggesting that LND is more readily performed robotically than laparoscopically.⁶⁵

Oncologic outcomes, including R0 resection rates, recurrence, and overall survival, appear comparable between open and minimally invasive approaches in appropriately selected patients.^67,68 The current consensus suggests that MILS is suitable for patients with a noncirrhotic liver or well-preserved liver function and without hilar, inferior vena cava, or major hepatic vein invasion that would require complex biliary or vascular reconstruction. Surgeons must carefully consider their experience and institutional resources when adopting these techniques.²²

Approximately 20-30% of patients with iCCA require extrahepatic bile duct resection and hepaticojejunostomy.^16,24 Biliary leakage and anastomotic stricture are clinically relevant because they can worsen long-term oncologic outcomes and delay or preclude the delivery of adjuvant chemotherapy.^69,70 Although data are limited, recent series have reported minimally invasive approaches for iCCA and perihilar CCA requiring biliary reconstruction. A meta-analysis comparing open and MIS for perihilar and iCCA, including patients who underwent hepaticojejunostomy, showed that the MIS group had lower complication rates (20.9% vs. 27.6%; OR, 0.88; 95% CI, 0.64-1.21) and mortality rates (4.2% vs. 4.9%; OR, 0.51; 95% CI, 0.30-0.86) and comparable rates of bile leakage (10.6% vs. 11.7%; OR, 0.83; 95% CI, 0.52-0.77).⁶⁷

NEOADJUVANT CHEMOIMMUNOTHERAPY AND CONVERSION SURGERY

Biliary tract cancers exhibit substantial intratumoral heterogeneity in tumor biology and the immune microenvironment.⁷¹ This heterogeneity provides a rationale for combining immune checkpoint inhibitors with cytotoxic chemotherapy.⁷² The TOPAZ-1 trial demonstrated that adding durvalumab to gemcitabine-cisplatin improved survival in patients with advanced biliary tract cancer, establishing gemcitabine-cisplatin plus durvalumab as the standard first-line systemic therapy.^73,74 Accordingly, current research is evaluating this regimen as neoadjuvant therapy in patients with locally advanced disease who are at high risk for R1/R2 resection. In the DEBATE trial, which enrolled 45 patients with locally advanced biliary tract cancer approximately 40% with iCCA, the durvalumab-gemcitabine-cisplatin arm achieved a higher objective response rate than gemcitabine-cisplatin alone (36% vs. 7%) and a greater proportion of patients proceeding to curative-intent surgery (61% vs. 36%).⁷⁵ Other studies have reported that neoadjuvant therapy may be particularly beneficial in patients with vascular involvement, markedly elevated carbohydrate antigen 19-9 (CA19-9)>500 U/mL, regional lymph node metastasis, or multifocal disease, with conversion to resection achieved in approximately 46% of such high-risk patients.^76,77 Although currently available data remain limited and heterogeneous, neoadjuvant chemoimmunotherapy appears to offer a new therapeutic opportunity for patients previously considered unresectable. Future work should aim to define the optimal indications, treatment regimens, and timing of surgery, and to clarify the role of adjuvant therapy after conversion resection (Fig. 2).

SURGICAL MANAGEMENT OF CHCC-CCA

Relative to HCC and iCCA, cHCC-CCA is a rare primary liver cancer characterized by hepatocytic and cholangiocytic differentiation and accounts for approximately 0.4-1.0% of all primary liver malignancies.^78,79 Standardized treatment guidelines are lacking because of its rarity and histologic heterogeneity. Additionally, surgical strategies often follow the principles established for HCC or iCCA.¹⁴

Preoperative diagnosis is particularly challenging, because imaging findings frequently overlap with those of HCC or iCCA. Arterial-phase hyperenhancement with washout in the delayed phase favors HCC, whereas peripheral rim enhancement followed by delayed progressive enhancement favors CCA. However, classic mixed imaging features are uncommon, and most tumors are misdiagnosed as HCC preoperatively.^80,81 When lesions show typical HCC enhancement combined with diffusion restriction or progressive delayed enhancement, cHCC-CCA should be considered.⁸² Histologic confirmation before surgery is difficult, and the diagnosis is often established on resection specimens.

Serum tumor markers may aid in diagnosis. Alpha-fetoprotein (AFP) elevation is observed in 50-60% of patients, and only approximately 20% have concomitant elevation of AFP and CA19-9.^83,84 Recently, radiomics and liquid biopsy-based models, including circulating tumor DNA mutation profiles, have been explored to differentiate HCC-like from CCA-like subtypes and may improve preoperative diagnosis and surgical planning.^85,86

Surgical resection remains the only potentially curative treatment for cHCC-CCA. Current guidelines recommend achieving an R0 margin and performing appropriate LND.^87,88 The reported 5-year overall survival after R0 resection ranges from 25% to 40%, a rate worse than that for typical HCC but comparable to or slightly better than that for iCCA. However, recent western multicenter data suggest outcomes similar to iCCA.^89-91 It is indisputable that achieving R0 resection is the fundamental surgical principle. However, the extent to which a resection margin is necessary to ensure optimal oncologic outcomes remains unclear. A recent meta-analysis reported that a wide margin of >1 cm significantly improved 5-year overall survival and recurrence-free survival in patients with iCCA.⁹² However, studies analyzing the impact of margin width, specifically in cHCC-CCA, are scarce due to the rarity of the disease. A recently published single-center study involving 80 patients demonstrated that patients with a wide margin had a significantly better prognosis compared to those with an R1 resection or a narrow margin of ≤2 mm.⁹³ Conversely, other studies utilizing a 1-cm cutoff failed to identify margin width as a significant prognostic factor.^94,95 However, these findings should be interpreted with caution given the limitations of small sample sizes and the single-center nature of the studies. In multifocal disease, a margin of at least 1 cm appears to be associated with improved outcomes.⁹⁶ Collectively, these findings underscore the need for large-scale international multi-center studies to define optimal oncologic surgical strategies, including the role of anatomical resection and margin extent.

Lymph node metastases occur in approximately 25-35% of cases, underscoring the importance of systematic LND for staging and guiding postoperative therapy.⁸⁹ Laparoscopic procedures yield perioperative and oncologic outcomes comparable to those of open surgery in selected patients.^97,98

Postoperative recurrence occurs in more than 60% of patients.^14,93 No standard adjuvant regimen has been established. However, recent studies have begun to evaluate adjuvant capecitabine- or immune checkpoint inhibitor-based strategies.^88,90 Given the biological heterogeneity and diagnostic challenges of cHCC-CCA, further research is needed to refine preoperative diagnostic algorithms and develop tailored surgical and systemic treatment approaches.

CONCLUSIONS

Surgical treatment remains a key component of curative-intent therapy for iCCA. Achieving R0 resection with adequate liver function and performing LND constitute the current standard of care. In appropriately selected patients, laparoscopic and robotic approaches performed by experienced surgeons yield oncologic outcomes comparable to open surgery, with additional benefits of reduced blood loss and shorter hospital stay. Emerging neoadjuvant chemoimmunotherapy regimens, such as gemcitabine-cisplatin plus durvalumab, show promise for downstaging locally advanced disease. and enabling conversion surgery. Despite persistent challenges in preoperative diagnosis, suspected cHCC-CCA should be managed according to oncologic principles of R0 resection with adequate margins and LND.

Article information

Conflicts of Interests

The authors have no conflicts of interests to declare.

Ethics Statement

Not applicable.

Funding Statement

This work was supported by the Asan Institute for Life Sciences (2025IF0046-1) and National Research Foundation of Korea funded by the Ministry of Science and ICT (RS-2025-24683021).

Data Availability

Not applicable.

Author Contributions

Conceptualization: WL, KPH, MS, SJL, DWH

Data curation: WL, JHL, MS, DWH, SCK

Formal analysis: WL, KPH, KBS, DWH

Funding acquisition: JHL, MS

Investigation: WL, KPH, JHL, ML

Methodology: SJL, KBS

Project administration: ML, SCK

Resources: SJL

Software: MS, SCK

Supervision: ML, SCK

Writing - original draft: WL, JHL, ML, SJL, KBS, DWH, SCK

Writing - review & editing: WL, JHL, ML, SJL, KBS, DWH, SCK

Figure 1.

Surgical management of intrahepatic cholangiocarcinoma (iCCA) from current practice to future directions. Schematic overview of key surgical issues in iCCA. The left panel illustrates a representative mass-forming iCCA within the liver. The central panel summarizes current surgical strategy. On the top, R0 liver resection requiring careful assessment of the future liver remnant and, when necessary, preoperative liver hypertrophy procedures (e.g., portal vein embolization, liver venous deprivation, or associating liver partitioning and portal vein ligation for staged hepatectomy). On the middle, regional lymph node dissection, including indication and extent, the controversial impact on oncologic outcomes, and emerging concepts such as fluorescence-guided sentinel lymph node mapping. On the bottom, extrahepatic bile duct resection with hepaticojejunostomy, which is required in approximately 20-30% of patients, particularly in mass-forming plus periductal- infiltrating tumors, and may be complicated by bile leak or anastomotic stricture that can delay adjuvant therapy. The right panel highlights future directions: expanding indications for minimally invasive liver resection in selected iCCA and the growing role of conversion surgery after neoadjuvant chemoimmunotherapy in initially locally advanced disease.

Figure 2.

Conversion surgery after neoadjuvant gemcitabine-cisplatin-durvalumab in a patient with advanced intrahepatic cholangiocarcinoma (iCCA). (A) A 72-year-old man was referred with a 5-cm mass-forming intrahepatic cholangiocarcinoma in segments VI, and VII detected on screening. Imaging suggested invasion of the bile duct bifurcation, inferior vena cava, right hepatic artery, and right portal vein, rendering the tumor borderline resectable. Endoscopic ultrasound-guided biopsy revealed adenocarcinoma of pancreatobiliary type and positron emission tomography-computed tomography (PET-CT) showed no distant metastasis. Baseline carbohydrate antigen 19-9 was 21.6 U/mL, indocyanine green retention rate at 15 minutes was 11.4%. (B) The patient received 11 cycles of neoadjuvant gemcitabine-cisplatin plus durvalumab, after which computed tomography on January 10, 2022 demonstrated marked tumor downsizing and reduced vascular involvement, allowing consideration of curative resection. (C) On January 13, 2022, the patient underwent an extended right hemihepatectomy with caudate lobectomy, extrahepatic bile duct resection with hepaticojejunostomy, and partial portal vein resection with bovine patch angioplasty. (D) Final pathology showed a 4.1×3.2×3.0 cm mass-forming iCCA in segment VI with negative margins. All 12 retrieved lymph nodes were negative for metastasis. The patient is currently receiving maintenance durvalumab.

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