Perihilar and Intrahepatic Cholangiocarcinoma after Resection: Clinicopathological Characteristics, Outcomes, and Implications for Addition of Chemoradiotherapy.

Background: The purpose of the present study was to evaluate clinicopathological characteristics, patterns of recurrence, survival outcomes, and implications for the addition of chemoradiotherapy for patients with resected perihilar and intrahepatic cholangiocarcinoma (CCA).

Materials And Methods: For the present retrospective study, we identified 38 and 10 patients with resected perihilar and intrahepatic CCA. In perihilar CCA, adjuvant treatment was given as chemotherapy ( = 13) or chemoradiotherapy ( = 10). In intrahepatic CCA, neoadjuvant treatment was given with transarterial chemoembolization (TACE, = 1) or chemotherapy plus stereotactic body radiation therapy (SBRT, = 1), and adjuvant treatment was given to 7 patients with chemotherapy or chemoradiotherapy.

Results: In perihilar CCA, preoperative biliary drainage procedures were performed in 27 out of 30 patients with jaundice. The adjacent liver showed secondary sclerosing cholangitis ( = 5) and fibrosis ( = 19). Locoregional recurrence involved the hepaticojejunostomy anastomotic site and lymph nodes. In intrahepatic CCA, the adjacent liver revealed cirrhosis ( = 1), secondary sclerosing cholangitis ( = 1), and fibrosis ( = 6). The sites of recurrence were in the remnant liver and lymph nodes ( = 6). In perihilar CCA, the median overall survival (OS) and disease-free survival (DFS) rates were 30.1 months (95% CI: 22.9-37.4) and 15.1 months (95% CI: 9.74-20.5), respectively. The 2-year and 3-year OS were 60.5% and 44.7%, respectively. Multivariate analysis revealed a significant association of no adjuvant treatment with decreased DFS ( = 0.004), HR 4.03 (95% CI: 1.57-10.4). Recurrence showed an unfavorable association with OS ( = 0.056), HR 2.90 (95% CI: 0.98-8.66). In intrahepatic CCA, the median OS and DFS rates were 41.2 months (95% CI: 13.5-68.9) and 10.8 months (95% CI: 1.98-19.6), respectively. The 2-year and 3-year OS were 66.7% and 53.3%, respectively. The patient with multiple intrahepatic CCA lesions and treated with neoadjuvant chemotherapy and SBRT showed partial pathological necrosis after resection and was disease-free at 3.5 years.

Conclusions: The present study showed the effectiveness of the combination of chemoradiotherapy with resection in improving locoregional disease control and survival in patients with perihilar and intrahepatic CCA.

How To Cite This Article: Sahai P, Rastogi A, Gupta A, Perihilar and Intrahepatic Cholangiocarcinoma after Resection: Clinicopathological Characteristics, Outcomes, and Implications for Addition of Chemoradiotherapy. Euroasian J Hepato-Gastroenterol 2024;14(2):134-144.