Shah Niket, Patkar Shraddha, Varty Gurudatt, Gundavda Kaival, Chaubal Gaurav, Goel Mahesh
Department of Gastrointestinal and Hepatobiliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
Max Nanavati Hospital, Mumbai, India.
Ann Surg Oncol. 2025 May 31. doi: 10.1245/s10434-025-17282-0.
Radical resection remains the only curative option for intrahepatic cholangiocarcinoma (iCCA). Patients with multifocal tumors, vascular invasion, or lymph node metastasis are considered to have locally advanced disease. Neoadjuvant chemotherapy with gemcitabine and cisplatin as first line or with capecitabine and irinotecan as second line have shown oncological benefit. More recently, Durvalumab has also showed benefit in addition to chemotherapy. For tumours with major vascular invasion, stereotactic body radiation therapy (SBRT) is a safe treatment option where upfront surgery may not provide the desired oncological outcomes. We present a video where combination of modalities was used to achieve downstaging followed by surgery.
A 64-year-old male patient was diagnosed with locally advanced iCCA involving left lobe with left portal vein thrombosis, left hepatic vein (LHV) encasement, and middle hepatic vein (MHV) abutment. Cancer antigen (CA) 19-9 was 1890 U/mL. After three cycles of gemcitabine and cisplatin, response computed tomography (CT) scan showed disease progression, and second-line chemotherapy with immunotherapy (capecitabine, irinotecan, durvalumab) was started with stereotactic body radiation therapy. Response CT showed significant size reduction. CA 19-9 dropped to 17 U/mL. Patient was planned for left hepatectomy with portal vein resection (PVR) and segment 8 venous reconstruction.
Resection with periportal lymphadenectomy and negative margins remains the only curative option for iCCA. Multimodality options can be utilized to downstage tumor, and complex liver resection with vascular reconstruction can achieve excellent oncological outcomes.
根治性切除术仍然是肝内胆管癌（iCCA）的唯一治愈选择。患有多灶性肿瘤、血管侵犯或淋巴结转移的患者被认为患有局部晚期疾病。以吉西他滨和顺铂作为一线方案或卡培他滨和伊立替康作为二线方案的新辅助化疗已显示出肿瘤学益处。最近，度伐利尤单抗在化疗基础上也显示出益处。对于有主要血管侵犯的肿瘤，立体定向体部放射治疗（SBRT）是一种安全的治疗选择，而直接手术可能无法提供理想的肿瘤学结果。我们展示一段视频，其中采用多种方式联合实现降期，随后进行手术。
一名64岁男性患者被诊断为局部晚期iCCA，累及左叶，伴有左门静脉血栓形成、左肝静脉（LHV）包绕和肝中静脉（MHV）毗邻。癌抗原（CA）19-9为1890 U/mL。在接受三个周期的吉西他滨和顺铂治疗后，反应性计算机断层扫描（CT）显示疾病进展，于是开始二线化疗联合免疫治疗（卡培他滨、伊立替康、度伐利尤单抗）并进行立体定向体部放射治疗。反应性CT显示肿瘤大小显著缩小。CA 19-9降至17 U/mL。计划对患者进行左肝切除术，同时进行门静脉切除（PVR）和第8段静脉重建。
门静脉周围淋巴结清扫且切缘阴性的切除术仍然是iCCA的唯一治愈选择。可采用多种方式使肿瘤降期，复杂的肝切除联合血管重建可取得优异的肿瘤学结果。
