A Case of Unresectable Intrahepatic Cholangiocarcinoma Treated by Conversion Surgery after GCD Therapy

Abstract

During therapy for chronic gastritis, an 80-year-old woman showed elevations in the liver function test. On imaging examination, a mass was found in the left lobe of the liver. The bile ducts of the left lobe were expanded and disrupted. And the tumor was suspected to have invaded the right hepatic artery. We diagnosed it as unresectable advanced intrahepatic cholangiocarcinoma (cT3N0M0 cStage III). We administered general chemotherapy with gemcitabine, cisplatin and durvalumab (GCD therapy). The treatment effect was PR (ycT2N0M0 ycStage II). The tumor had shrunk on CT. We determined that it was possible to preserve the right hepatic artery and decided to perform the conversion surgery. We performed left hepatic lobectomy and caudate lobectomy, extrahepatic bile duct resection, and biliary reconstruction. The pathological diagnosis was intrahepatic cholangiocarcinoma ypT2a (SS) N0M0 ypStage IIA. Only a few tumor cells remained in the left hepatic duct (CT-Grade3). Postoperative course was almost smooth, and she was discharged on postoperative day 23. Recently unresectable intrahepatic cholangiocarcinoma that becomes operable after chemotherapy is increasing, but there are no reports of conversion surgery after GCD therapy in Japan. We report a case of intrahepatic cholangiocarcinoma treated by GCD therapy and conversion surgery, along with a review of the literature.