Management of distal cholangiocarcinoma with arterial involvement: Systematic review and case series on the role of neoadjuvant therapy  

作　　者：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 

机构地区：[1]Department of Hepatopancreatobiliary Surgery and Liver Transplantation,University Hospitals Birmingham NHS Foundation Trust,Birmingham B152GW,United Kingdom [2]Institute of Immunology and Immunotherapy,University of Birmingham,Birmingham B152TT,United Kingdom [3]College of Medical and Dental Sciences,University of Birmingham,Birmingham B152TT,United Kingdom [4]Institute of Clinical Sciences,University of Birmingham,Birmingham B152TT,United Kingdom

出　　处：《World Journal of Gastrointestinal Surgery》2024年第8期2689-2701,共13页世界胃肠外科杂志（英文版）（电子版）

摘　　要：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 highvolume 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 postoperatively.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.

关 键 词：CHOLANGIOCARCINOMA Neoadjuvant therapy Arterial involvement Locally advanced Systematic review 

分 类 号：R735.37[医药卫生—肿瘤]