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

BACKGROUNDS/AIMS: Approximately 60–80% of patients with intrahepatic cholangiocarcinoma (iCCA) are not suitable for surgical resection due to advanced disease at presentation. This review assesses the role of surgical resection followed by down staging treatment in the management of patients with lo...

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Autores principales: Kamarajah, Sivesh, Giovinazzo, Francesco, Roberts, Keith J., Punia, Pankaj, Sutcliffe, Robert P., Marudanayagam, Ravi, Chatzizacharias, Nikolaos, Isaac, John, Mirza, Darius F., Muiesan, Paolo, Dasari, Bobby VM
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Association of Hepato-Biliary-Pancreatic Surgery 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7061034/
https://www.ncbi.nlm.nih.gov/pubmed/32181423
http://dx.doi.org/10.14701/ahbps.2020.24.1.6
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author Kamarajah, Sivesh
Giovinazzo, Francesco
Roberts, Keith J.
Punia, Pankaj
Sutcliffe, Robert P.
Marudanayagam, Ravi
Chatzizacharias, Nikolaos
Isaac, John
Mirza, Darius F.
Muiesan, Paolo
Dasari, Bobby VM
author_facet Kamarajah, Sivesh
Giovinazzo, Francesco
Roberts, Keith J.
Punia, Pankaj
Sutcliffe, Robert P.
Marudanayagam, Ravi
Chatzizacharias, Nikolaos
Isaac, John
Mirza, Darius F.
Muiesan, Paolo
Dasari, Bobby VM
author_sort Kamarajah, Sivesh
collection PubMed
description BACKGROUNDS/AIMS: Approximately 60–80% of patients with intrahepatic cholangiocarcinoma (iCCA) are not suitable for surgical resection due to advanced disease at presentation. This review assesses the role of surgical resection followed by down staging treatment in the management of patients with locally advanced iCCA. METHODS: A systematic review and pooled analysis were performed of the relevant published studies published between January 2000-December 2018. The primary outcome measure was overall survival. Secondary outcome measures were rates of clinical benefit, margin-negative (R0) resections, overall and surgery-specific complications, and post-operative mortality. RESULTS: Eighteen cohort studies with 1880 patients were included in the review. The median overall survival in all patients was 14 months (range, 7–18 months). Patients undergoing resection following down staging had significantly longer survival than those who did not (median: 29 vs. 12 months, p<0.001). The Clinical Benefit Rate with this strategy (complete response+partial response+stable disease) was 64% (244/383), ranging from 33-90%. Thirty-eight percent of the patients underwent resections with a 60% R0 resection rate and 6% postoperative mortality. CONCLUSIONS: Although the evidence to support the benefits of NAT for iCCA is limited, the review supports the use of down staging treatment and also surgical resection in the cohort with response to NAT in order to improve long-term survival in patients with locally advanced iCCA.
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spelling pubmed-70610342020-03-16 The role of down staging treatment in the management of locally advanced intrahepatic cholangiocarcinoma: Review of literature and pooled analysis Kamarajah, Sivesh Giovinazzo, Francesco Roberts, Keith J. Punia, Pankaj Sutcliffe, Robert P. Marudanayagam, Ravi Chatzizacharias, Nikolaos Isaac, John Mirza, Darius F. Muiesan, Paolo Dasari, Bobby VM Ann Hepatobiliary Pancreat Surg Review Article BACKGROUNDS/AIMS: Approximately 60–80% of patients with intrahepatic cholangiocarcinoma (iCCA) are not suitable for surgical resection due to advanced disease at presentation. This review assesses the role of surgical resection followed by down staging treatment in the management of patients with locally advanced iCCA. METHODS: A systematic review and pooled analysis were performed of the relevant published studies published between January 2000-December 2018. The primary outcome measure was overall survival. Secondary outcome measures were rates of clinical benefit, margin-negative (R0) resections, overall and surgery-specific complications, and post-operative mortality. RESULTS: Eighteen cohort studies with 1880 patients were included in the review. The median overall survival in all patients was 14 months (range, 7–18 months). Patients undergoing resection following down staging had significantly longer survival than those who did not (median: 29 vs. 12 months, p<0.001). The Clinical Benefit Rate with this strategy (complete response+partial response+stable disease) was 64% (244/383), ranging from 33-90%. Thirty-eight percent of the patients underwent resections with a 60% R0 resection rate and 6% postoperative mortality. CONCLUSIONS: Although the evidence to support the benefits of NAT for iCCA is limited, the review supports the use of down staging treatment and also surgical resection in the cohort with response to NAT in order to improve long-term survival in patients with locally advanced iCCA. Korean Association of Hepato-Biliary-Pancreatic Surgery 2020-02 2020-02-27 /pmc/articles/PMC7061034/ /pubmed/32181423 http://dx.doi.org/10.14701/ahbps.2020.24.1.6 Text en Copyright © 2020 by The Korean Association of Hepato-Biliary-Pancreatic Surgery http://creativecommons.org/licenses/by-nc/4.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review Article
Kamarajah, Sivesh
Giovinazzo, Francesco
Roberts, Keith J.
Punia, Pankaj
Sutcliffe, Robert P.
Marudanayagam, Ravi
Chatzizacharias, Nikolaos
Isaac, John
Mirza, Darius F.
Muiesan, Paolo
Dasari, Bobby VM
The role of down staging treatment in the management of locally advanced intrahepatic cholangiocarcinoma: Review of literature and pooled analysis
title The role of down staging treatment in the management of locally advanced intrahepatic cholangiocarcinoma: Review of literature and pooled analysis
title_full The role of down staging treatment in the management of locally advanced intrahepatic cholangiocarcinoma: Review of literature and pooled analysis
title_fullStr The role of down staging treatment in the management of locally advanced intrahepatic cholangiocarcinoma: Review of literature and pooled analysis
title_full_unstemmed The role of down staging treatment in the management of locally advanced intrahepatic cholangiocarcinoma: Review of literature and pooled analysis
title_short The role of down staging treatment in the management of locally advanced intrahepatic cholangiocarcinoma: Review of literature and pooled analysis
title_sort role of down staging treatment in the management of locally advanced intrahepatic cholangiocarcinoma: review of literature and pooled analysis
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7061034/
https://www.ncbi.nlm.nih.gov/pubmed/32181423
http://dx.doi.org/10.14701/ahbps.2020.24.1.6
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