The role of down staging treatment in the management of locally advanced intrahepatic cholangiocarcinoma: Review of literature and pooled analysis

Sivesh Kamarajah; Francesco Giovinazzo; Keith J. Roberts; Pankaj Punia; Robert P. Sutcliffe; Ravi Marudanayagam; Nikolaos Chatzizacharias; John Isaac; Darius F. Mirza; Paolo Muiesan; Bobby VM Dasari

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저자정보: Sivesh Kamarajah (Queen Elizabeth Hospital) Francesco Giovinazzo (Queen Elizabeth Hospital) Keith J. Roberts (Queen Elizabeth Hospital) Pankaj Punia (Queen Elizabeth Hospital) Robert P. Sutcliffe (Queen Elizabeth Hospital) Ravi Marudanayagam (Queen Elizabeth Hospital) Nikolaos Chatzizacharias (Queen Elizabeth Hospital) John Isaac (Queen Elizabeth Hospital) Darius F. Mirza (Queen Elizabeth Hospital) Paolo Muiesan (Queen Elizabeth Hospital) Bobby VM Dasari (Queen Elizabeth Hospital)

저널정보: 한국간담췌외과학회 Annals of Hepato-Biliary-Pancreatic Surgery 한국간담췌외과학회지 제24권 제1호

발행연도: 2020.2

수록면: 6 - 16 (11page)

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Backgrounds/Aims: Approximately 60-80% of patients with intrahepatic cholangiocarcinoma (iCCA) are not suitable for surgical resection due to advanced disease at presentation. This review assesses the role of surgical resection followed by down staging treatment in the management of patients with locally advanced iCCA. Methods: A systematic review and pooled analysis were performed of the relevant published studies published between January 2000-December 2018. The primary outcome measure was overall survival. Secondary outcome measures were rates of clinical benefit, margin-negative (R0) resections, overall and surgery-specific complications, and post-operative mortality. Results: Eighteen cohort studies with 1880 patients were included in the review. The median overall survival in all patients was 14 months (range, 7-18 months). Patients undergoing resection following down staging had significantly longer survival than those who did not (median: 29 vs. 12 months, p＜0.001). The Clinical Benefit Rate with this strategy (complete response+partial response+stable disease) was 64% (244/383), ranging from 33-90%. Thirty-eight percent of the patients underwent resections with a 60% R0 resection rate and 6% postoperative mortality. Conclusions: Although the evidence to support the benefits of NAT for iCCA is limited, the review supports the use of down staging treatment and also surgical resection in the cohort with response to NAT in order to improve long-term survival in patients with locally advanced iCCA.

#Intrahepatic #Cholangiocarcinoma #Locally advanced #Down staging #Surgery

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