International survey on the use of preoperative chemotherapy in the setting of multimodality management of intrahepatic cholangiocarcinoma.

BACKGROUND

Indication to neoadjuvant chemotherapy and resectability of intrahepatic cholangiocarcinoma (iCCA) are not clearly defined. Aim of this survey was to assess practice patterns of iCCA treatment.

METHODS

Data were collected from an online survey approved by the International Hepato-Pancreato-Biliary Association consisting of 33 questions.

RESULTS

Of 167 surgeons surveyed from 44 countries, 83 % work at academic centers and 74.8 % routinely discuss iCCA cases in a multidisciplinary setting. Criteria of unresectability in absence of distant metastases included: insufficient future liver remnant volume (82.0 %), inability to obtain negative margins (71.3 %), contralateral nodules (62.9 %), contact with future remaining portal pedicles (49.1 %) and hepatic veins (44.3 %), multiple unilateral/satellite nodules (31.3 %), and positive regional lymph nodes (19.8 %). The most common indications for preoperative chemotherapy were initially unresectable disease (91.6 %) and radiologically enlarged regional lymph nodes (40.1 %). When planning hepatectomy for iCCA, 74.8 % of surgeons surveyed would consider administering neoadjuvant chemotherapy to increase the likelihood of achieving R0 resection (80.0 %), shrink tumor (81.6 %), and select patients with favorable tumor biology (73.6 %).

CONCLUSION

While expert consensus would help define unresectability for iCCA, preoperative chemotherapy is considered a suitable tool to help downstage disease and select patients with favorable tumor characteristics to increase R0 resection rates.