Gemcitabine-Based Adjuvant Chemotherapy Improves Survival After Aggressive Surgery for Hilar Cholangiocarcinoma

Abstract

Postoperative adjuvant gemcitabine-based chemotherapy may be a promising strategy to improve survival after surgical resection for hilar cholangiocarcinoma. A prospective randomized study should be done to confirm the results of this study.

Surgical strategy for bile duct cancer: Advances and current limitations

“…Reports from high-volume centers during the last decade are summarized in Table 2 [26, 45,71,73,128,135,142,[146][147][148][149][150][151][152][153][154][155][156][157][158][159][160] . The overall 3-and 5-year survival rates after radical surgery ranged from 37% to 60% and 20% to 42%, respectively.…”

“…A recent multicenter randomized trial evaluated the effect of adjuvant chemotherapy with mitomycin C and 5-FU versus surgery alone for patients with pancreato-biliary malignancies, in which no survival benefit was seen for 139 patients with R0 resection for cholangiocarcinoma [186] . Recent institutional retrospective experiences found that gemcitabine-based adjuvant chemotherapy after curative-intent surgery significantly improved patient survival [160,187] . In summary, gemcitabine in combination with cisplatin or oxaliplatin seems to be the most efficacious regimen in cholangiocarcinoma, but adjuvant chemotherapy alone cannot yet be considered standard therapy after resection.…”

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“…Even for patients with positive lymph node status or incomplete surgical resection, modern adjuvant protocols offer a chance of improved long-term survival. 26 Especially in these cases, LT does not represent an option as recurrence rates under immunosuppression have shown to be unacceptably high. [27][28][29] If extended extrahepatic bile duct resection, including pancreatic head resection in combination with LT, leads to improved survival in extrahepatic CCA patients; however, partly because of increased perioperative mortality, most centers do not have improved results with this patient collective.…”

“…[27][28][29] If extended extrahepatic bile duct resection, including pancreatic head resection in combination with LT, leads to improved survival in extrahepatic CCA patients; however, partly because of increased perioperative mortality, most centers do not have improved results with this patient collective. [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] For patients with anatomically unresectable Klatskin tumors or considerable parenchymal damage, extended liver resection is not a choice. For these patients, LT is the only chance for a potential cure.…”

“…44 Gemcitabine plus cisplatin has been shown to improve patient survival in the R1-or palliative situation of CCA. 2,26 Therefore, one may speculate that perioperative protocols including these substances may improve long-term survival of CCA LT patients further.…”