Robotic partial hepatectomy following immunotherapy for advanced intrahepatic cholangiocarcinoma

Abstract

Background: Metastatic Intrahepatic cholangiocarcinoma (iCCA) carries a poor prognosis, with upfront hepatic resection of the primary tumor contraindicated. Response rates to systemic chemotherapy are low and confer only a modest survival benefit. Next generation sequencing (NGS) is useful for identifying potentially actionable mutations for therapeutic targets. For patients with a high tumor mutational burden, immunotherapy can produce a profound decrease in tumor size and distribution. Immunotherapy for iCCA is growing, and a dramatic response to immunotherapy may downstage previously unresectable iCCA, expanding the role for surgery in this complex biliary malignancy. There are a limited number of case reports describing successful hepatic resection of previously metastatic iCCA after immunotherapy. Herein, we report our experience performing a robotic partial hepatectomy for clearance of the only identifiable active disease 3 years after diagnosis and downstaging of metastatic iCCA with PD-1 blockage for microsatellite high instability (MSI High).