Published online Aug 27, 2024. doi: 10.4240/wjgs.v16.i8.2689
Revised: May 28, 2024
Accepted: June 27, 2024
Published online: August 27, 2024
Processing time: 154 Days and 3.1 Hours
The use of neoadjuvant therapy (NAT) in distal cholangiocarcinoma (dCCA) with regional arterial or extensive venous involvement, is not widely accepted and evi
To synthesise evidence on NAT for dCCA and present the experience of a high-volume tertiary-centre managing dCCA with arterial involvement.
A systematic review was performed according to PRISMA guidance to identify all studies reporting outcomes of patients with dCCA who received NAT. All patients from 2017 to 2022 who were referred for NAT for dCCA at our centre were retrospectively collected from a prospectively maintained database. Baseline characteristics, NAT type, progression to surgery and oncological outcomes were collected.
Twelve studies were included. The definition of “unresectable” locally advanced dCCA was heterogenous. Four studies reported outcomes for 9 patients who received NAT for dCCA with extensive vascular involvement. R0 resection rate ranged between 0 and 100% but without survival benefit in most cases. Remaining studies considered either NAT in resectable dCCA or inclusive with extrahepatic CCA. The presented case series includes 9 patients (median age 67, IQR 56-74 years, male:female 5:4) referred for NAT for borderline resectable or locally advanced disease. Three patients progressed to surgery and 2 were resected. One patient died at 14 months with evidence of recurrence at 6 months and the other died at 51 months following recurrence 6 months post-operatively.
Evidence for benefit of NAT is limited. Consensus on criteria for uniform definition of resectability for dCCA is required. We propose using the established National-Comprehensive-Cancer-Network® criteria for pancreatic ductal adenocarcinoma.
Core Tip: Use of neoadjuvant therapy in distal cholangiocarcinoma (dCCA) with regional arterial or extensive venous involvement, is not widely accepted and evidence is sparse. This systematic review highlights heterogeneity of definitions and outcome reporting. Consensus on criteria for a uniform definition of resectability for dCCA is required to provide homogenous reporting of pathways and outcomes. We propose the use of the already established National-Comprehensive-Cancer-Network® criteria for pancreatic ductal adenocarcinoma and exemplify this with our case series. Future studies should focus on international observational high-quality studies and prospective registries to account for the rare nature of the disease.