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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Management of distal cholangiocarcinoma with arterial involvement: Systematic review and case series on the role of neoadjuvant therapy
Lewis A Hall, Duncan Loader, Santiago Gouveia, Marta Burak, James Halle-Smith, Peter Labib, Moath Alarabiyat, Ravi Marudanayagam, Bobby V Dasari, Keith J Roberts, Syed S Raza, Michail Papamichail, David C Bartlett, Robert P Sutcliffe, Nikolaos A Chatzizacharias
Lewis A Hall, Santiago Gouveia, Marta Burak, James Halle-Smith, Peter Labib, Moath Alarabiyat, Ravi Marudanayagam, Bobby V Dasari, Keith J Roberts, Syed S Raza, Michail Papamichail, David C Bartlett, Robert P Sutcliffe, Nikolaos A Chatzizacharias, Department of Hepatopancreatobiliary Surgery and Liver Transplantation, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, United Kingdom
Lewis A Hall, James Halle-Smith, Keith J Roberts, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, United Kingdom
Duncan Loader, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom
Nikolaos A Chatzizacharias, Institute of Clinical Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom
Author contributions: Chatzizacharias N conceptualized the work; Hall LA, Loader D Gouveia S, Burak M, Halle-Smith J, Labib P, and Alarabiyat M completed data collection and analysis for the case series; Hall LA, Gouveia S, Burak M, and Halle-Smith J completed the systematic review; Hall LA, Loader D, Halle-Smith J, and Chatzizacharias N prepared the original draft; Labib P, Alarabiyat M, Marudanayagam R, Dasari BVM, Roberts KJ, Raza SS, Papamichail M, Bartlett DC, Sutcliffe RP, and Chatzizacharias N reviewed and edited the manuscript; Chatzizacharias N was senior supervisor for the project; and all authors have read and approved the final version of the manuscript.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist and attached checklist for submission.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Nikolaos A Chatzizacharias, BM BCh, FACS, FRCS, PhD, Surgeon, Department of Hepatopancreatobiliary Surgery and Liver Transplantation, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2GW, United Kingdom.
chatzizacharias@gmail.com
Received: March 15, 2024
Revised: May 28, 2024
Accepted: June 27, 2024
Published online: August 27, 2024
Processing time: 154 Days and 3.1 Hours
BACKGROUND
The use of neoadjuvant therapy (NAT) in distal cholangiocarcinoma (dCCA) with regional arterial or extensive venous involvement, is not widely accepted and evidence is sparse.
AIM
To synthesise evidence on NAT for dCCA and present the experience of a high-volume tertiary-centre managing dCCA with arterial involvement.
METHODS
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.
RESULTS
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.
CONCLUSION
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.
