[Curative Resection after Chemotherapy for Advanced Extensive Cholangiocarcinoma-A Case Report].

Area of Science:

• Gastroenterology and Hepatology
• Surgical Oncology
• Medical Oncology

Background:

• Cholangiocarcinoma (bile duct cancer) often presents with extensive disease, precluding curative surgical resection.
• Systemic chemotherapy is a common treatment modality for unresectable cholangiocarcinoma.
• Conversion surgery, after neoadjuvant therapy, is an evolving strategy for initially unresectable cancers.

Observation:

• A 73-year-old male with extensive cholangiocarcinoma received gemcitabine and cisplatin (GC) therapy for approximately one year.
• Following 11 courses of GC, no tumor progression was observed, and a bile duct mapping biopsy showed decreased atypia.
• The patient subsequently underwent a successful pancreaticoduodenectomy with histopathologically negative margins.

Findings:

• The patient achieved a Grade IIa response according to the Evans classification.
• At 23 months post-treatment initiation and 12 months post-surgery, the patient remains recurrence-free without adjuvant chemotherapy.
• This outcome suggests the potential efficacy of conversion surgery in selected cholangiocarcinoma cases.

Implications:

• Conversion surgery may offer favorable long-term outcomes for patients with initially unresectable cholangiocarcinoma.
• This case supports further investigation into neoadjuvant therapy followed by surgical resection for biliary tract cancers.
• The findings contribute to the growing, albeit limited, evidence base for conversion surgery in this challenging malignancy.