Adjuvant chemotherapy after resection in perihilar cholangiocarcinoma may improve survival, a new study published in the European Journal of Surgical Oncology found.

“These findings suggest incorporation of [adjuvant chemotherapy] into multimodality therapy for [perihilar cholangiocarcinoma] in all cases, where appropriate,” the authors said. However, It is not clear whether adjuvant chemotherapy following resection is beneficial in patients with perihilar cholangiocarcinoma.

“There remains an ongoing dilemma regarding the role of [adjuvant chemotherapy] after [perihilar cholangiocarcinoma] resection,” the authors wrote. “Whilst guidelines from [National Comprehensive Cancer Network] advocate adjuvant therapy for margin-positive [perihilar cholangiocarcinoma] resections, this is less clear from the European Society of Medical Oncology.”


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Here, a team of researchers led by Steven A. White, MB, ChB, MD, FRCS, from the Newcastle Freeman Hospital in Tyne, England investigated whether adjuvant chemotherapy can improve long-term survival in patients with perihilar cholangiocarcinoma following resection surgery.

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Using data from the National Cancer Database, the researchers identified patients with the disease who were treated with resection between 2010 and 2016. Around half of these patients received adjuvant chemotherapy and half did not. 

Following statistical analyses, the researchers found that adjuvant chemotherapy was associated with improved survival. This was the case even in margin-negative and node-negative disease.

Cholangiocarcinoma is a heterogeneous group of rare malignant tumors originating in the cells of the biliary tree in the liver. There are different types of cholangiocarcinoma. Perihilar and distal cholangiocarcinoma both develop from the cells of the biliary epithelium and peribiliary glands.

Cholangiocarcinoma is typically treated with surgery and adjuvant therapy. Patients with perihilar cholangiocarcinoma may also benefit from liver transplantations but only if their tumors are smaller than 3 cm and have not metastasized, and they have no history of endoscopic biopsy.

Reference

Kamarajah SK, Al-Rawashdeh W, Parente A, et al. Adjuvant chemotherapy for perihilar cholangiocarcinoma: a population-based comparative cohort study. Eur J Surg Oncol. Published online December 11, 2021. doi:10.1016/j.ejso.2021.12.002