Perioperative and oncologic outcomes of vascular resection after neoadjuvant therapy in intrahepatic cholangiocarcinoma
Yawen Dong1, David Pereyra2, Zhihao Li3
1Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA; Department of Surgery, HPB Center, Vienna Health Network, Clinic Favoriten and Sigmund Freud Private University, Vienna, Austria.
Background:
Intrahepatic cholangiocarcinoma (iCCA) with major vascular involvement is a technically challenging and biologically aggressive clinical scenario. Although vascular resection (VR) can be performed at experienced centers, the oncologic value of this approach depends on appropriate patient selection. We evaluated whether neoadjuvant therapy (NAT) may improve selection and outcomes among patients undergoing hepatectomy with concomitant VR.
Methods:
A single-institution cohort study of 349 patients who underwent resection for histologically confirmed iCCA between 2000 and 2024 was performed. Patients were stratified by VR status and, within the VR cohort, by receipt of NAT. Overall survival (OS) and recurrence-free survival (RFS) were analyzed using Kaplan-Meier methods and Cox regression, including an interaction term between NAT and VR.
Results:
Twenty-eight patients (8.0%) underwent major VR, including 11 who received NAT. Compared with patients without VR, those undergoing VR had higher-risk disease and higher 90-day mortality, but similar long-term survival. Within the VR cohort, NAT-treated patients had more adverse baseline clinicopathologic features, yet recurrence occurred less frequently than after upfront VR (27% vs. 82%; p = 0.006). In adjusted analyses restricted to the VR cohort, NAT was associated with improved RFS (HR 0.21; p = 0.041). In the full cohort, the NAT×VR interaction was borderline significant (HR 0.27; p = 0.050), suggesting a potential concentration of the NAT-associated RFS benefit among patients requiring VR.
Conclusions:
In patients with iCCA requiring major vascular resection, NAT may improve biologic selection and may be associated with more favorable recurrence-free outcomes despite adverse baseline disease features. Given the small NAT + VR subgroup, these results should be interpreted as hypothesis-generating and warrant validation in larger prospective multicenter cohorts.