Case: Authentic multimodal therapy and liver resection for an initially unresectable intrahepatic cholangiocarcinoma

Koichiro Sakata; Daiki Kijima; Taizo Yamaguchi; Takashi Furuhashi; Toshihiko Abe; Haruki Iwamoto; Katsuhiko Morita

doi:10.1016/j.ijscr.2018.08.059

Case: Authentic multimodal therapy and liver resection for an initially unresectable intrahepatic cholangiocarcinoma

Int J Surg Case Rep. 2018:51:409-414. doi: 10.1016/j.ijscr.2018.08.059. Epub 2018 Sep 15.

Authors

Koichiro Sakata¹, Daiki Kijima², Taizo Yamaguchi³, Takashi Furuhashi⁴, Toshihiko Abe⁴, Haruki Iwamoto³, Katsuhiko Morita²

Affiliations

¹ Japan Seafares Relief Association, Ekisaikai Moji Hospital, 1-3-1 Kiyotaki, Mojiku, Kitakyushu, Fukuoka, 801-8550, Japan. Electronic address: k.sakata@kousei-h.jp.
² JCHO Shimonoseki Medical Center, 3-21-25 kamishinchi-machi, Shimonoseki, Yamaguchi, 750-0061, Japan.
³ Iwamoto Clinic, 1-2-8 Shimoishida, Kokuraminamiku, Kitakyushu, Fukuoka, 802-0832, Japan.
⁴ Japan Seafares Relief Association, Ekisaikai Moji Hospital, 1-3-1 Kiyotaki, Mojiku, Kitakyushu, Fukuoka, 801-8550, Japan.

Abstract

Introduction: Although curative resection is an outstanding prognostic factor of intrahepatic cholangiocarcinoma (ICC), certain segments remain unresectable. The standard therapy for initially unresectable ICC is uncertain. In this case report, we reported the feasibility of multimodal chemotherapy and curative resection.

Case: A 59-year-old Asian woman with back pain was referred to the hospital by her family physician regarding liver mass visible on ultrasonography. At admission, the carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) levels were high, and images showed characteristic signs of ICC with intrahepatic metastases and invasions to on the right Glisson's sheath. Multimodal therapy was applied to the ICC, which could not be resected at first. The therapy comprised hepatic arterial chemoembolization with drug-eluting beads (DEB-TACE), angiographic subsegmentectomy (AS), and systemic chemotherapy. Downstaging of the ICC, which results in curative resection, was planned due to non-normalization of the tumor markers, and pathological analysis revealed complete remission. At 34 months after the surgery, the patient was alive without relapse.

Discussion: Recently, chemotherapy and/or an interventional approach were reported to be feasible, although unresectable advanced ICC has a poor prognosis. Some studies have reported that multimodal chemotherapy and R0 resection of initially unresectable ICC can prolong survival time. However, some reports have shown high morbidity and mortality associated with initially unresectable ICC treated with multimodal chemotherapy and R0 resection. Our study resulted in complete remission without complications.

Conclusion: Multimodal chemotherapy and hepatic curative resection on locally advanced ICC are feasible treatment approaches for initially unresectable ICC.

Keywords: Case report; Curative liver resection; Drug-eluting beads; Hepatic arterial chemo-embolization; Initially unresectable; Intrahepatic cholangiocarcinoma.