Preoperative chemotherapy for intrahepatic cholangiocarcinoma

Abstract

Intrahepatic cholangiocarcinoma (ICC) is often diagnosed in advanced tumor extent because of late onset of symptoms. Thus, many tumors are irresectable at initial presentation. The role of preoperative chemotherapy in initially irresectable ICC is still controversial. The aim was to analyse the effect of preoperative chemotherapy on overall and recurrence-free survival. All patients undergoing surgical exploration for ICC (n = 176) were recorded prospectively (2008–2016). Analyses focussed on application of preoperative chemotherapy and re-evaluation after initially assumed irresectability. Overall and recurrence free survival were analysed using Kaplan Meier model. Perioperative deaths were excluded in survival analyses. Out of 176 explorations 10 patients had received preoperative chemotherapy. 8 patients underwent curative intended resection while in 2 patients resection was not reasonable due to a too small or impaired future liver remnant. Comparing overall survival after resection with (n = 8) and without preoperative chemotherapy (n = 119) no significant difference could be shown (p = 0.754; median OS 17.9 months with [range 1–90] vs. 17.5 months without [range 6–48]). The same result was achieved for recurrence-free survival (n = 0.797). Out of 49 irresectable tumors, diagnosed at exploration, 42 received chemotherapy, but none reached secondary resectability. Patients who received preoperative chemotherapy reaching exploration and curative intended resection have a comparable overall and recurrence-free survival to patients with initially resectable tumors. Therefore, it is important to perform regular re-staging imaging in patients who undergo chemotherapy for irresectable ICC and discuss these cases interdisciplinary at a tertiary center for liver surgery.