Conversion surgery for unresectable perihilar cholangiocarcinoma after Gemcitabine, Cisplatin and Durvalumab combination chemotherapy: A case report

Abstract

A 69-year-old man was diagnosed as perihilar cholangiocarcinoma Bismuth IIIa with right hepatic artery invasion and hilar lymph node metastasis. It took 2 months to improve the jaundice by ENBD drainage for the future liver remnant. Reexamination of the computed tomography revealed tumor extension with portal vein invasion and progression of lymph node metastasis, and ICG Krem was 0.036. Since R0 resection was not expected and the remaining liver volume was insufficient, we judged that the patient was unresectable. We changed to both lobes drainage using inside stents, and started combination chemotherapy with Gemcitabine, Cisplatin and Durvalumab. After 5 courses, the local extension of the tumor and lymph node metastasis significantly shrunk, and ICG Krem improved to 0.049. Therefore, conversion surgery was performed seven months after the diagnosis. Postoperative pathological findings showed poorly differentiated adenocarcinoma measuring 4×3mm remained in the hilar bile duct, and hilar lymph node metastasis had disappeared. The diagnosis was pT2aN1M0 Stage IIIC, and R0 resection was achieved. In addition, there was a large amount of CD8-positive lymphocytes, and the lesions expressed PD-L1, suggesting an immune-mediated antitumor effect of Durvalumab.