Multidisciplinary Approach to Perihilar and Intrahepatic Cholangiocarcinoma: A Single-Center Experience

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Gastroenterology

Background:

• Perihilar cholangiocarcinoma (PHCC) and intrahepatic cholangiocarcinoma (IHCC) present significant treatment challenges.
• Effective management strategies for these biliary tract cancers are crucial for improving patient outcomes.

Purpose of the Study:

• To investigate the clinical characteristics of PHCC and IHCC.
• To evaluate the outcomes of a specific treatment policy for these cancers.
• To identify prognostic factors influencing overall survival (OS).

Main Methods:

• Retrospective analysis of 117 patients diagnosed with PHCC or IHCC between January 2007 and September 2023.
• Evaluation of postoperative outcomes and prognostic factors affecting OS.
• Surgical resection performed in 47 patients; preoperative biliary drainage used in most PHCC cases.

Main Results:

• Mortality rate was 8.5%, with a complication rate of 68.1%.
• R0 resection rate was 73% in PHCC; mean OS was 26.5 months for R0 resected PHCC and 28.7 months for resected IHCC.
• High CA19-9 levels, lymphovascular invasion, positive surgical margins, and acute renal failure were associated with poorer OS. Positive margins and elevated CA19-9 were independent poor prognostic factors.

Conclusions:

• Surgical resection remains the cornerstone of multidisciplinary treatment for PHCC and IHCC.
• Adjuvant chemotherapy may improve OS.
• Advanced IHCC management may involve loco-regional therapies, repeat surgery, and systemic chemotherapy.