Laparoscopic Extended Segmentectomy 8 with Right Hepatic Vein Resection After Conversion Therapy for Advanced Intrahepatic Cholangiocarcinoma.

Abstract

Background: Most patients with intrahepatic cholangiocarcinoma (ICC) are diagnosed at advanced stages and are thus ineligible for surgery. Recently, a combination of immunotherapy, chemotherapy, and lenvatinib has shown promising results for treating advanced ICC.^1-3 Laparoscopic anatomical liver resection of segment 8 remains challenging.^4,5 We present a case of advanced ICC treated with durvalumab, gemcitabine plus oxaliplatin (GEMOX), and lenvatinib, followed by laparoscopic extended segmentectomy 8 using indocyanine green (ICG) fluorescent staining.

Methods: A 54-year-old patient was found to have a hepatic tumor in segment 8, with invasion into the right hepatic vein and multiple enlarged lymph nodes, confirmed by abdominal computed tomography (CT). After six cycles of conversion therapy, partial response was achieved. The patient then underwent laparoscopic extended segmentectomy 8 and right hepatic vein resection. Preoperative planning with three-dimensional (3D) reconstruction, along with intraoperative ultrasonography and ICG-guided fluorescent staining, greatly enhanced the precision and success of the surgery.

Results: The operation lasted 220 min with an estimated blood loss of 800 mL. The Pringle maneuver was performed intermittently six times for a total of 85 min. The patient was discharged on the 12th postoperative day without complications. Postoperatively, the patient received adjuvant therapy with durvalumab and capecitabine, ⁶ achieving recurrence-free survival for over 6 months.

Conclusions: Cases of patients with advanced ICC undergoing surgical resection after immunotherapy and chemotherapy are rare. The combination of GEMOX, durvalumab, and lenvatinib showed promising antitumor efficacy and safety, suggesting its potential as a feasible and safe conversion therapy for advanced ICC.