Neoadjuvant therapy, especially neoadjuvant chemoradiation therapy, is associated with better postoperative outcomes in patients with extrahepatic cholangiocarcinoma, according to a new study published in the Journal of Surgical Oncology. 

The authors of the study said that their findings support the expansion of the use of neoadjuvant chemoradiation therapy for the treatment of patients with extrahepatic cholangiocarcinoma.

Little is known about the effectiveness of neoadjuvant therapy in extrahepatic cholangiocarcinoma. To characterize treatment trends, identify factors associated with receipt of neoadjuvant therapy, and assess the associations between neoadjuvant therapy and postoperative outcomes, a team of researchers led by Ryan P. Merkow, MD, MS, from the Department of Surgery, Northwestern University Feinberg School of Medicine, in Chicago, IL, conducted a retrospective cohort study using data from the National Cancer Database.

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Read more about the subtypes of cholangiocarcinoma

The team analyzed data from 8040 patients between 2004 and 2017. Of these, 417 (5.2%) received neoadjuvant therapy.

The researchers identified factors associated with the receipt of neoadjuvant therapy as being 50 years of age or less and more advanced disease stage (stage 3). 

They also found that patients who were treated with neoadjuvant therapy had higher odds of R0 resection and lower 30-day mortality compared to those who had surgery first. 

Neoadjuvant chemotherapy was not associated with differences in any outcomes. However, neoadjuvant chemoradiation therapy was associated with improvements in R0 resection and median survival compared to surgery first.

Cholangiocarcinoma is a group of rare malignant tumors originating from the cells of the biliary tree. Based on the anatomical origin of the tumor, there are 3 different subtypes of cholangiocarcinoma: intrahepatic, perihilar, and distal. Perihilar and distal cholangiocarcinoma are classed as extrahepatic diseases.

Treatment typically involves surgical intervention. This is sometimes complemented with adjuvant therapies such as targeted radiation therapy. The disease is considered resistant to chemotherapy.


Silver CM, Joung RH, Logan CD, et al. Neoadjuvant therapy use and association with postoperative outcomes and overall survival in patients with extrahepatic cholangiocarcinoma. J Surg Oncol. Published online October 4, 2022. doi:10.1002/jso.27112