Impact of Gemcitabine Plus S1 Neoadjuvant Chemotherapy on Borderline Resectable Perihilar Cholangiocarcinoma

Matsuyama, Ryusei; Mori, Rintaro; Ota, Yoshihide; Homma, Yoshimi; Yabusita, Yasuhiro; Hiratani, Seigo; Murakami, Takashi; Sawada, Yu; Miyake, Kentaro; Shimizu, Yasuhiro; Kumamoto, Takafumi; Endo, Itaru

doi:10.1245/s10434-021-11206-4

Cited by 12 publications

(6 citation statements)

References 43 publications

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“…They reported that the median survival time was 50.1 months for the resected patients. For the resected patients, the estimated 3‐year survival rate was 55.8%, and the estimated 5‐year survival rate was 36.4% 82 . On the contrary, it has been reported that preoperative chemotherapy does not affect prognosis 83 .…”

Section: Neoadjuvant Therapy (Nac)mentioning

confidence: 94%

Essential updates 2021/2022: Update in surgical strategy for perihilar cholangiocarcinoma

Kawano,

Yoshioka,

Ichida

et al. 2023

Annals of Gastroent Surgery

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Resection is the only potential curative treatment for perihilar cholangiocarcinoma (PHC); however, complete resection is often technically challenging due to the anatomical location. Various innovative approaches and procedures were invented to circumvent this limitation but the rates of postoperative morbidity (20%–78%) and mortality (2%–15%) are still high. In patients diagnosed with resectable PHC, deliberate and coordinated preoperative workup and optimization of the patient and future liver remnant are crucial. Biliary drainage is recommended to relieve obstructive jaundice and optimize the clinical condition before liver resection. Biliary drainage for PHC can be performed either by endoscopic biliary drainage or percutaneous transhepatic biliary drainage. To date there is no consensus about which method is preferred. The volumetric assessment of the future remnant liver volume and optimization mainly using portal vein embolization is the gold standard in the management of the risk to develop post hepatectomy liver failure. The improvement of systemic chemotherapy has contributed to prolong the survival not only in patients with unresectable PHC but also in patients undergoing curative surgery. In this article, we review the literature and discuss the current surgical treatment of PHC.

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Section: Neoadjuvant Therapy (Nac)mentioning

confidence: 94%

Essential updates 2021/2022: Update in surgical strategy for perihilar cholangiocarcinoma

Kawano,

Yoshioka,

Ichida

et al. 2023

Annals of Gastroent Surgery

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“…Resection with curative intent was performed in 43 of 60 patients (72%), and among those, R0 resection was achieved in 81%. OS was 55.8 months in resected group versus 36.4 months in the unresectable group 44…”

Section: Methodsmentioning

confidence: 86%

“…OS was 55.8 months in resected group versus 36.4 months in the unresectable group. 44 Limited data suggest that neoadjuvant CRT may also improve locoregional control and survival by helping to facilitate margin-negative resection (R0), clearance of microscopic locoregional disease spread, and selecting optimal surgical candidates. [45][46][47] Jung reported a multi-institutional retrospective series of 57 patients with perihilar cholangiocarcinoma comparing up-front surgery (n = 45) versus neoadjuvant CRT (n = 12) 45 to 50.4 Gy with concurrent 5-FU or gemcitabine.…”

Section: Neoadjuvant Therapymentioning

confidence: 99%

American Radium Society (ARS) Appropriate Use Criteria (AUC) for Extrahepatic Cholangiocarcinoma

Tchelebi¹,

Jethwa

Levy³

et al. 2022

American Journal of Clinical Oncology

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Although uncommon, extrahepatic cholangiocarcinoma (EHCC) is a deadly malignancy, and the treatment approaches remain controversial. While surgery remains the only cure, few patients are candidates for resection up front, and there are high rates of both local and distant failure following resection. Herein, we systematically review the available evidence regarding treatment approaches for patients with EHCC, including surgery, radiation, and chemotherapy. The evidence regarding treatment outcomes was assessed using the Population, Intervention, Comparator, Outcome, and Study design (PICOS) framework. A summary of recommendations based on the available literature is outlined for specific clinical scenarios encountered by providers in the clinic to guide the management of these patients.

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“…Despite primary surgical resection, most pCCA patients are not cured of their disease, as disease recurrence is about 80% within the following eight years, with frequent sites of recurrence in the liver, portal lymph nodes, and peritoneum [ 20 ]. For this reason, several centres propose chemoradiotherapy (CRT) not only as neoadjuvant treatment in borderline resectable pCCA (at present, there is no evidence that neoadjuvant CRT is beneficial) [ 21 ], but also as an adjuvant approach to enhance surgical results in cases with lymph nodes positive for disease spread [ 22 ].…”

Section: Results Of Surgical Resection In Pccamentioning

confidence: 99%

Current Perspectives in Liver Transplantation for Perihilar Cholangiocarcinoma

et al. 2023

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Cholangiocarcinoma (CCA) encompasses all malignant neoplasms arising from the epithelial cells of the biliary tree. About 40% of CCAs are perihilar, involving the bile ducts distal to the second-order biliary branches and proximal to the cystic duct implant. About two-thirds of pCCAs are considered unresectable at the time of diagnosis or exploration. When resective surgery is deemed unfeasible, liver transplantation (LT) could be an effective alternative. The overall survival rates after LT at 1 and 3 years are 91% and 81%, respectively. The overall five-year survival rate after transplantation is 73% (79% for patients with underlying PSC and 63% for de novo pCCA). Multicenter case series reported a 5-year disease-free survival rate of ~65%. However, different protocols, including neoadjuvant therapy, have been proposed. The scarcity of organ availability represents a crucial limiting factor in recommending LT preferentially in treating pCCA. Living donor transplantations and marginal cadaveric allografts have proven to be exciting options to overcome organ shortage. Management of jaundice and cholangitis is still challenging for these patients and could impact LT listing. Whether to adopt surgical resection or LT as standard-of-care in pCCA is still a matter of debate, and more prospective studies are needed.

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Impact of Gemcitabine Plus S1 Neoadjuvant Chemotherapy on Borderline Resectable Perihilar Cholangiocarcinoma

Cited by 12 publications

References 43 publications

Essential updates 2021/2022: Update in surgical strategy for perihilar cholangiocarcinoma

Essential updates 2021/2022: Update in surgical strategy for perihilar cholangiocarcinoma

American Radium Society (ARS) Appropriate Use Criteria (AUC) for Extrahepatic Cholangiocarcinoma

Current Perspectives in Liver Transplantation for Perihilar Cholangiocarcinoma

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