Safety and efficacy of neoadjuvant chemotherapy based on our resectability criteria for locally advanced perihilar cholangiocarcinoma.

Abstract

PURPOSE:

Neoadjuvant chemotherapy (NAC) is not commonly used for perihilar cholangiocarcinoma (PHC). This study evaluated the safety and efficacy of NAC for PHC.

METHODS:

Ninety-one PHC patients without metastases were treated at our department. Patients were classified as resectable (R), borderline resectable (BR), or locally advanced unresectable (LA). Upfront surgery (US) was performed for R-PHC patients without regional lymph node metastases (LNM) or those unable to tolerate NAC. The NAC regimen comprised two courses of gemcitabine-based chemotherapy for advanced PHC: R-PHC with LNM, BR, and LA.

RESULTS:

US and NAC were performed on 32 and 59 patients, respectively. For US, 31 patients underwent curative intent surgery (upfront-CIS). NAC caused adverse effects in 10/59 (17%), allowed 36/59 (61%) to undergo curative intent surgery (NAC-CIS) without impairing liver function, and spared 23/59 (39%) from undergoing resection (NAC-UR). Overall survival was better in the upfront-CIS and NAC-CIS groups than in the NAC-UR group (MST: 74 vs 57 vs 17 months, p < 0.001). In 59 NAC patients, tumour size response occurred in 11/11 (100%) of R, 22/33 (66.7%) of BR, and 9/15 (60.0%) of LA patients. The un-resection rate was the highest in the LA group (27% [3/11] than in R, 30% [10/33] in BR, and 67% [10/15] in LA, p = 0.039). Multivariate analyses revealed that LA and age were independent risk factors for non-resection after NAC.

CONCLUSION:

was safe and contributed to improving survival in advanced PHC patients. R-PHC was responsive to NAC, but LA remains a risk factor for non-resection through NAC.

• Authors: Kazuyuki Gyoten, Naohisa Kuriyama, Koki Maeda, Takahiro Ito, Aoi Hayasaki, Takehiro Fujii, Yusuke Iizawa, Akihiro Tanemura, Yasuhiro Murata, Masashi Kishiwada, Shugo Mizuno
• Journal: Langenbeck's archives of surgery (Langenbecks Arch Surg) Vol. 408 Issue 1 Pg. 261 (Jul 01 2023) ISSN: 1435-2451 [Electronic] Germany
• PMID: 37392289 (Publication Type: Journal Article)
• Copyright: © 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Topics

• Humans
• Klatskin Tumor (drug therapy, surgery)
• Neoadjuvant Therapy
• Cholangiocarcinoma
• Bile Duct Neoplasms (drug therapy, surgery)
• Bile Ducts, Intrahepatic