HPB SO18 - Management of distal cholangiocarcinoma with arterial involvement: Systematic review and case series on the role of neoadjuvant therapy

Abstract

Abstract Background The use of neoadjuvant therapy (NAT) in distal cholangiocarcinoma (dCCA) with regional arterial or extensive venous involvement, is not widely accepted and evidence is sparse. The aim of this study was synthesise evidence on NAT for dCCA and present the experience of a high-volume tertiary-centre managing dCCA with arterial involvement. Method A systematic review was performed according to PRISMA guidance to identify all studies reporting outcomes of patients with dCCA who received NAT. All patients from 2017 to 2022 who were referred for NAT for dCCA at our centre were retrospectively collected from a prospectively maintained database. Baseline characteristics, NAT type, progression to surgery and oncological outcomes were collected. Results Twelve studies were included. Definition of “unresectable” locally-advanced-dCCA was heterogenous. Four studies reported outcomes for 9 patients who received NAT for dCCA with vascular involvement. R0 rate ranged between 0 and 100% but without survival benefit in most cases. Remaining studies considered NAT in resectable dCCA or with extrahepatic-CCA. The case series includes 9 patients (median age 67, IQR 56-74 years, male:female 5:4) referred for NAT for borderline-resectable or locally-advanced disease. Three patients progressed to surgery and 2 were resected. One patient died at 14 months, and one died at 51 months. Both had recurrence 6 months post-operatively. Conclusion From our own series and included studies that report on NAT for dCCA with extensive vascular involvement, evidence for the benefit of NAT is limited. Consensus on the criteria for a uniform definition of resectability for dCCA is required, which will provide homogeneity in reporting of pathways and outcomes. We propose the use of the already established National Comprehensive Cancer Network® criteria for PDAC.