Feasibility of major hepatectomy following preoperative chemotherapy for advanced perihilar cholangiocarcinoma

Atsushi Takahashi; Ryuji Yoshioka; Shuichi Koike; Masahiro Fujisawa; Masaru Oba; Yoshinori Takeda; Yuki Fukumura; Yoshihito Kotera; Yoshihiro Mise; Akio Saiura

doi:10.1016/j.ejso.2024.108733

Feasibility of major hepatectomy following preoperative chemotherapy for advanced perihilar cholangiocarcinoma

Eur J Surg Oncol. 2024 Oct 1:108733. doi: 10.1016/j.ejso.2024.108733. Online ahead of print.

Affiliations

¹ Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
² Department of Human Pathology, Juntendo University School of Medicine, Tokyo, Japan.
³ Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan. Electronic address: saiura-tky@umin.ac.jp.

PMID: 39419746
DOI: 10.1016/j.ejso.2024.108733

Abstract

Background: The safety of major hepatectomy following preoperative chemotherapy for perihilar cholangiocarcinoma (PHCC) is underexplored. This study evaluates the impact of preoperative chemotherapy on surgical outcomes and assesses chemotherapy-induced liver injury in patients with advanced PHCC.

Methods: This retrospective study included 62 PHCC patients who underwent surgery between January 2019 and January 2024. Patients were divided into an upfront surgery group (UFS, n = 31) and a preoperative chemotherapy group (POC, n = 31). Preoperative chemotherapy was indicated when R0/R1 resection was unachievable, complex surgery was needed, or future liver reserve was insufficient. Baseline characteristics, surgical procedures, postoperative complications, and pathological findings were compared.

Results: Postoperative complications were comparable between groups, with Clavien-Dindo grade ≥3a rates of 30.7 % in the POC group and 24.3 % in the UFS group. Despite longer operative times and hospital stays in the POC group, no significant differences in hepatotoxicity or pathological findings, including Kleiner and Rubbia-Brandt scores, were observed. Notably, a pathological complete response was achieved in 12.9 % of the POC group.

Conclusion: Major hepatectomy following preoperative chemotherapy for PHCC is safe and does not increase the risk of postoperative complications or hepatotoxicity. Further studies are warranted to refine resectability criteria and optimize patient selection.

Keywords: Perihilar cholangiocarcinoma; Preoperative chemotherapy; Surgical and pathological outcomes.