Intrahepatic cholangiocarcinoma - Influence of preoperative therapy on long-term outcome

Abstract

Introduction: Intrahepatic cholangiocarcinoma (ICC) is often diagnosed in advanced tumor stage. Preoperative therapy for downsizing is moderately investigated, often applied in palliative intention and not standardized, yet. We want to share our experience with secondary resectability for different kinds of preoperative therapy. Methods: All patients who underwent exploration for ICC between 2008 and June 2018 were collected in a database and retrospectively analysed. Kaplan Meier model and log rang test were utilized for statistics. Result: We report on 210 patients who underwent surgery with 150 resection and 60 explorations. Eighteen of these patients underwent preoperative therapy. Chemotherapy was most often applied with 14 patients, in one patient in combination with SIRT. Two patients underwent TACE, two other ablation. Secondary resection was possible in 13 patients (chemotherapy n=11, TACE n=1, ablation n=1). Median overall survival (OS) was 27 months for the preoperative therapy group (PTG) and 23.4 months for the primary resection group (noPTG). The consecutive 1-, 3- and 5-year overall survival from the day of resection is 77%, 42% and 14% for the PTG and 79%, 31% and 17% for the noPTG, respectively. OS was comparable between these two groups calculated from the day of resection (p=0.542). If calculated from the day of diagnosis the PTG had a better long-term survival without reaching significance (p=0.061). Recurrence-free survival (RFS) is 31% at one-year for the PTG with no 3- or 5-year RFS. The noPTG had 39%, 18% and 13%, respectively (p=0.155). Conclusion: Overall survival calculated from the day of resection and recurrence-free survival for patients who undergo secondary resection after preoperative therapy is comparable between patients who underwent primary resection or secondary resection after preoperative therapy. If calculated from the day of diagnosis OS is slightly better for patients who underwent preoperative therapy.