International survey on the use of preoperative chemotherapy in the setting of multimodality management of intrahepatic cholangiocarcinoma.

IF 2.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2025-08-09 DOI:10.1016/j.hpb.2025.08.001

Elena Panettieri, Agostino M De Rose, Eduardo A Vega, William T Kawahara, Alessandro Coppola, Francesco Ardito, Felice Giuliante

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引用次数: 0

Abstract

Background: Indication to neoadjuvant chemotherapy and resectability of intrahepatic cholangiocarcinoma (iCCA) are not clearly defined. Aim of this survey was to assess practice patterns of iCCA treatment.

Methods: Data were collected from an online survey approved by the International Hepato-Pancreato-Biliary Association consisting of 33 questions.

Results: Of 167 surgeons surveyed from 44 countries, 83 % work at academic centers and 74.8 % routinely discuss iCCA cases in a multidisciplinary setting. Criteria of unresectability in absence of distant metastases included: insufficient future liver remnant volume (82.0 %), inability to obtain negative margins (71.3 %), contralateral nodules (62.9 %), contact with future remaining portal pedicles (49.1 %) and hepatic veins (44.3 %), multiple unilateral/satellite nodules (31.3 %), and positive regional lymph nodes (19.8 %). The most common indications for preoperative chemotherapy were initially unresectable disease (91.6 %) and radiologically enlarged regional lymph nodes (40.1 %). When planning hepatectomy for iCCA, 74.8 % of surgeons surveyed would consider administering neoadjuvant chemotherapy to increase the likelihood of achieving R0 resection (80.0 %), shrink tumor (81.6 %), and select patients with favorable tumor biology (73.6 %).

Conclusion: While expert consensus would help define unresectability for iCCA, preoperative chemotherapy is considered a suitable tool to help downstage disease and select patients with favorable tumor characteristics to increase R0 resection rates.

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术前化疗在肝内胆管癌多模式治疗中的应用国际调查。

背景：肝内胆管癌（iCCA）的新辅助化疗适应症和可切除性尚不明确。本调查的目的是评估iCCA治疗的实践模式。方法：数据收集自国际肝胆胰协会批准的在线调查，包括33个问题。结果：在来自44个国家的167名外科医生中，83%在学术中心工作，74.8%在多学科环境中常规讨论iCCA病例。无远处转移的不可切除标准包括：未来肝残余体积不足（82.0%），无法获得阴性边缘（71.3%），对侧结节（62.9%），接触未来剩余门脉蒂（49.1%）和肝静脉（44.3%），多发单侧/卫星结节（31.3%）和阳性区域淋巴结（19.8%）。术前化疗最常见的适应症是最初不可切除的疾病（91.6%）和放射学上扩大的区域淋巴结（40.1%）。在计划iCCA肝切除术时，74.8%的受访外科医生会考虑给予新辅助化疗，以增加实现R0切除（80.0%）、缩小肿瘤（81.6%）和选择肿瘤生物学有利的患者（73.6%）的可能性。结论：虽然专家共识有助于确定iCCA的不可切除性，但术前化疗被认为是一种合适的工具，可以帮助降低疾病的分期，选择具有良好肿瘤特征的患者，以提高R0切除率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).