scholarly journals The role of down staging treatment in the management of locally advanced intrahepatic cholangiocarcinoma: Review of literature and pooled analysis

2020 ◽  
Vol 24 (1) ◽  
pp. 6 ◽  
Author(s):  
Sivesh Kamarajah ◽  
Francesco Giovinazzo ◽  
Keith J. Roberts ◽  
Pankaj Punia ◽  
Robert P. Sutcliffe ◽  
...  
Keyword(s):  
Intrahepatic Cholangiocarcinoma ◽  
Locally Advanced ◽  
Pooled Analysis ◽  
Review Of Literature

scholarly journals Staging Laparoscopy in Patients with Intrahepatic Cholangiocarcinoma: Is It Still Useful?

2020 ◽  
Vol 36 (6) ◽  
pp. 501-505
Author(s):  
Lotte C. Franken ◽  
Robert Jan S. Coelen ◽  
Eva Roos ◽  
Joanne Verheij ◽  
Saffire S. Phoa ◽  
...  
Keyword(s):  
Intrahepatic Cholangiocarcinoma ◽  
Locally Advanced ◽  
Distant Metastases ◽  
Staging Laparoscopy ◽  
Preoperative Imaging ◽  
Unresectable Disease ◽  
Advanced Tumor ◽  
Distant Lymph Node Metastasis ◽  
Severe Cirrhosis

<b><i>Background:</i></b> The role of staging laparoscopy in patients with intrahepatic cholangiocarcinoma remains unclear. Despite extensive preoperative imaging, approximately 25% of patients are deemed unresectable at laparotomy due to metastasized disease. The aim of this study was to evaluate the frequency of unresectable disease found at staging laparoscopy and to identify predictors for detecting metastasized intrahepatic cholangiocarcinoma. <b><i>Methods:</i></b> We retrospectively collected records of all patients with intrahepatic cholangiocarcinoma, presenting at our institution from 2008 to 2017. Staging laparoscopy was performed on the suspicion of distant metastases and on indication in larger tumors. The yield and sensitivity of staging laparoscopy was calculated. Reasons for unresectability at staging laparoscopy or laparotomy were recorded. <b><i>Results:</i></b> Among a total of 80 patients with potentially resectable intrahepatic cholangiocarcinoma, 35 patients underwent staging laparoscopy on the suspicion of distant metastases. Unresectable disease was found at staging laparoscopy in 15 patients. Reasons for unresectability were liver metastasis (<i>n</i> = 6), peritoneal metastasis (<i>n</i> = 4), severe cirrhosis (<i>n</i> = 2), locally advanced tumor with satellite lesions (<i>n</i> = 1), and distant lymph node metastasis (<i>n</i> = 2). Considering optimal preoperative imaging, the true yield of staging laparoscopy was 20% (7/35). Two patients did not undergo laparotomy due to progression after staging laparoscopy. Of the remaining 18 patients who underwent laparotomy, 6 patients (30%) had unresectable disease, mostly because of distant metastasis (<i>n</i> = 4). <b><i>Conclusions:</i></b> The role of staging laparoscopy to detect unresectable intrahepatic cholangiocarcinoma is highly dependent on the quality of preoperative imaging. Currently, no accurate selection criteria on imaging exist to select patients with intrahepatic cholangiocarcinoma who potentially benefit from staging laparoscopy.

scholarly journals Surgical Treatment of Intrahepatic Cholangiocarcinoma: Current and Emerging Principles

2020 ◽  
Vol 10 (1) ◽  
pp. 104
Author(s):  
Eliza W. Beal ◽  
Jordan M. Cloyd ◽  
Timothy M. Pawlik
Keyword(s):  
Intrahepatic Cholangiocarcinoma ◽  
Early Stage ◽  
Preoperative Evaluation ◽  
Locally Advanced ◽  
Surgical Techniques ◽  
Future Liver Remnant ◽  
Surgical Morbidity ◽  
Early Stage Disease ◽  
Liver Remnant

Intrahepatic cholangiocarcinoma (ICC) is a rare, aggressive cancer of the biliary tract. It often presents with locally advanced or metastatic disease, but for patients with early-stage disease, surgical resection with negative margins and portahepatis lymphadenectomy is the standard of care. Recent advancements in ICC include refinement of staging, improvement in liver-directed therapies, clarification of the role of adjuvant therapy based on new randomized controlled trials, and advances in minimally invasive liver surgery. In addition, improvements in neoadjuvant strategies and surgical techniques have enabled expanded surgical indications and reduced surgical morbidity and mortality. However, recurrence rates remain high and more effective systemic therapies are still necessary to improve recurrence-free and overall survival. In this review, we focus on current and emerging surgical principals for the management of ICC including preoperative evaluation, current indications for surgery, strategies for future liver remnant augmentation, technical principles, and the role of neoadjuvant and adjuvant therapies.

scholarly journals Successful Treatment of stage IIIb intrahepatic Cholangiocarcinoma After Neoadjuvant Therapy With PD-1blockade Camrelizumab: A Case Report and Review of Literature

2021 ◽  
Author(s):  
Shuguang Zhu ◽  
Haibo Li ◽  
Jianwen Zhang ◽  
Chunhui Qiu ◽  
Tianxing Dai ◽  
...  
Keyword(s):  
Case Report ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Neoadjuvant Therapy ◽  
Successful Treatment ◽  
Intrahepatic Cholangiocarcinoma ◽  
Review Of Literature ◽  
Nccn Guidelines ◽  
Node Metastasis

Abstract Prognosis of ICC with lymph node metastasis is poor. And the feasibility of operation is uncertain, which is a contraindication in NCCN guidelines. In addition, in the neoadjuvant therapy of ICC, the role of immunotherapy is not clear. We describe a case of ICC with lymph node metastasis was successfully treated with neoadjuvant therapy.

Adjuvant therapy in resected pancreatic cancer: A systematic review of literature with meta-analysis of randomized clinical trials.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 342-342
Author(s):  
Fabrizio Drudi ◽  
Davide Tassinari ◽  
Claudio Ridolfi ◽  
Alessandra Affatato ◽  
Emiliano Tamburini ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pancreatic Cancer ◽  
Survival Rate ◽  
Adjuvant Chemotherapy ◽  
Odds Ratio ◽  
Pooled Analysis ◽  
Phase Iii ◽  
Number Needed To Treat ◽  
Review Of Literature

342 Background: To assess the role of adjuvant treatments (AT), adjuvant chemotherapy (AC) and adjuvant chemo-radiotherapy (ACR) in resected pancreatic adenocarcinoma. Methods: A systematic review of literature in the MEDLINE and EMBASE data bases from 1966 to 2011 was independently performed by two authors (FD and DT). All the randomized phase III trials investigating the role of AT in radically resected pancreatic cancer were considered eligible and included into the pooled analysis. 5-year-survival rate in patients treated with AT was the primary end point of the trial, 5-year-survival rate of patients treated with AC and ACR, and the 5-year-survival number needed to treat (NNT) of AT, AC and ACR were the secondary ones. Results: The outcomes of 1402 patients enrolled in 8 trials were compared in the pooled analysis. 816 patients were treated with AT (540 with AC and 276 with ACR), and 586 were enrolled in the control arm (no adjuvant treatment). Significant improve in 5-year-survival rate was observed for AT and AC (odds ratio of 0.636, p<0.05 and 0.422, p<0.01 respectively), but not for ACR (odds ratio=1.139, p=0.489), with a 5-year survival NNT of 20, 10 and 38 respectively for AT, AC and ACR. Low to moderate heterogeneity between the trials was documented both for AT (I2=58%) and AC (I2=31.63%), but not for ACR (I2=0%,). Conclusions: Our data confirm that adjuvant chemotherapy improves the 5-year survival rate in radically resected cancer patients and gemctabine based regimens seem to be better than FU based regimens.

scholarly journals The Role of Surgical Resection and Liver Transplantation for the Treatment of Intrahepatic Cholangiocarcinoma

2021 ◽  
Vol 10 (11) ◽  
pp. 2428
Author(s):  
Guergana Panayotova ◽  
Jarot Guerra ◽  
James V. Guarrera ◽  
Keri E. Lunsford
Keyword(s):  
Liver Transplantation ◽  
Surgical Resection ◽  
Intrahepatic Cholangiocarcinoma ◽  
Locally Advanced ◽  
Tumor Biology ◽  
Future Liver Remnant ◽  
Patient Treatment ◽  
Term Survival ◽  
Liver Remnant

Intrahepatic cholangiocarcinoma (iCCA) is a rare and complex malignancy of the biliary epithelium. Due to its silent presentation, patients are frequently diagnosed late in their disease course, resulting in poor overall survival. Advances in molecular profiling and targeted therapies have improved medical management, but long-term survival is rarely seen with medical therapy alone. Surgical resection offers a survival advantage, but negative oncologic margins are difficult to achieve, recurrence rates are high, and the need for adequate future liver remnant limits the extent of resection. Advances in neoadjuvant and adjuvant treatments have broadened patient treatment options, and these agents are undergoing active investigation, especially in the setting of advanced, initially unresectable disease. For those who are not able to undergo resection, liver transplantation is emerging as a potential curative therapy in certain cases. Patient selection, favorable tumor biology, and a protocolized, multidisciplinary approach are ultimately necessary for best patient outcomes. This review will discuss the current surgical management of locally advanced, liver-limited intrahepatic cholangiocarcinoma as well as the role of liver transplantation for select patients with background liver disease.

scholarly journals The role of downstaging neoadjuvant therapy in the management of locally advanced Intrahepatic Cholangiocarcinoma (iCCA): A Systematic Review and Meta-Analysis

HPB ◽  
2020 ◽  
Vol 22 ◽  
pp. S252
Author(s):  
S. Kathir Kamarajah ◽  
M. Abradelo ◽  
R. Sutcliffe ◽  
R. Marudanayagam ◽  
N. Chatzizacharias ◽  
...  
Keyword(s):  
Systematic Review ◽  
Neoadjuvant Therapy ◽  
Intrahepatic Cholangiocarcinoma ◽  
Meta Analysis ◽  
Locally Advanced
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