AB055. 214. Management of cholangiocarcinoma: the national experience
Upper GI/Hepatobiliary Session

AB055. 214. Management of cholangiocarcinoma: the national experience

Fiona Hand1, Mark Sheehan1, Naoimh O’Farrell1, Iqbal Masood1, Ross Mac Nicholas2, Diarmuid Houlihan2, Aidan McCormack2, Donal Maguire3, Justin Geoghegan3, Emir Hoti3

1Department of Surgery, 2Department of Hepatology, 3Department of Hepatobiliary and Liver Transplant Surgery, St. Vincent’s Hospital, Elm Park, Dublin, Ireland

Background: The prognosis for cholangiocarcinoma remains poor with only 20% amenable to surgical resection at diagnosis. Furthermore, initial experiences with transplantation for unresectable cholangiocarcinoma demonstrated poor outcomes. The Mayo Clinic published 5-year survival rates of 70% following the novel addition of neoadjuvant chemoradiotherapy pretransplant. Here, we examine different management approaches for cholangiocarcinoma.

Methods: From 2005 to 2017, all patients undergoing liver surgery for cholangiocarcinoma were identified from a prospectively maintained histological database. Clinicopathological data were obtained and variables associated with long-term survival following second hepatectomy were identified by Cox regression analyses and reviewed along with 30-day post-operative morbidity and mortality.

Results: Seventy-six cholangiocarcinomas were treated with curative intent. Twenty-six (34.2%) unresectable cholangiocarcinomas completed the Mayo-protocol. The remaining 50 (65.8%) underwent resection, predominantly right-extended hepatectomy. liver transplant (LT) group was significantly younger (P=0.05), with 75% demonstrating primary sclerosing cholangitis on histological analysis. There were 4 (16.7%) in-hospital deaths in the LT group compared with 3 (7.9%) in the resection group (P=0.288). Excluding these from long-term survival analysis; there was a trend towards increased survival in Mayo-protocol patients (mean 6.7 vs. 3.8 years) (P=0.082). LT tumours were significantly smaller (P<0.0001), with 65% demonstrating a complete pathologic response to neoadjuvant chemoradiation. Survival was significantly increased in T0 tumours compared with patients with residual disease (P=0.005).

Conclusions: This study highlights the efficacy of Mayo protocol in carefully selected patients, with 55% actual 5-year survival rates, 65% having a complete pathologic response to neoadjuvant therapy.

Keywords: Cholangiocarcinoma; resection; transplant; mayo; protocol

doi: 10.21037/map.2019.AB055
Cite this abstract as: Hand F, Sheehan M, O’Farrell N, Masood I, Mac Nicholas R, Houlihan D, McCormack A, Maguire D, Geoghegan J, Hoti E. Management of cholangiocarcinoma: the national experience. Mesentery Peritoneum 2019;3:AB055.

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