Postoperative adjuvant chemotherapy for resectable cholangiocarcinoma

Area of Science:

• Oncology
• Gastroenterology
• Surgical Oncology

Background:

• Cholangiocarcinoma (bile duct cancer) is aggressive, with high recurrence rates after surgical resection.
• Postoperative adjuvant chemotherapy aims to eradicate residual disease and micrometastatic lesions.
• The benefits and harms of adjuvant chemotherapy after surgery for cholangiocarcinoma remain unclear.

Purpose of the Study:

• To assess the benefits and harms of postoperative adjuvant chemotherapy versus placebo, no intervention, or other chemotherapy regimens.
• To evaluate outcomes for patients with cholangiocarcinoma following curative-intent resection.

Main Methods:

• Systematic review and meta-analysis of randomized clinical trials.
• Searched multiple databases including Cochrane, MEDLINE, and Embase up to April 2021.
• Included 5 trials with 931 participants; assessed risk of bias and certainty of evidence using GRADE.

Main Results:

• Very uncertain effect of adjuvant chemotherapy on all-cause mortality (RR 0.92; 4 trials, very low-certainty evidence).
• Very uncertain effect on serious adverse events, with one trial suggesting increased risk (RR 17.82; 1 trial, very low-certainty evidence).
• Limited data on specific regimens and cholangiocarcinoma-only populations; no data on quality of life or recurrence.

Conclusions:

• Very low-certainty evidence necessitates caution regarding the benefits and harms of adjuvant chemotherapy for cholangiocarcinoma.
• High risk of bias and imprecision limit current conclusions.
• Further well-designed, adequately powered randomized clinical trials are essential to establish optimal adjuvant chemotherapy strategies.