Behind The Knife: The Surgery Podcast Clinical Challenges in Surgical Oncology: Intrahepatic Cholangiocarcinoma - Hope in the Face of Nihilism
Jan 23, 2023
Gilbert Murimwa, a surgical oncology researcher and general surgery resident, joins Caitlin Hester, a liver and pancreatic cancer surgeon, to explore intrahepatic cholangiocarcinoma. They discuss diagnostic workup, biopsy decisions, resectability, lymphadenectomy, and surgical strategy. The conversation also covers adjuvant and systemic therapies, immunotherapy trials, surveillance, and molecular targets including FGFR2 and IDH1.
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Imaging Must Establish Diagnosis And Resectability
- High-quality multiphase CT or MRI both characterizes the mass and determines resectability.
- Because ICC is often a diagnosis of exclusion, staging includes chest imaging, tumor markers, and upper and lower endoscopy for other primaries.
Reserve Biopsy For Uncertain Or Advanced Disease
- Avoid routine preoperative biopsy for a solitary, localized, potentially curable tumor when the clinical and imaging picture is convincing.
- Obtain tissue when disease is multifocal or unresectable, because diagnosis and molecular testing become more important.
Neoadjuvant Therapy Remains A Selective Strategy
- Neoadjuvant treatment remains investigational for resectable ICC, despite promising disease control in high-risk patients.
- The NeoGAP study reported a 27% partial response rate and 90% disease-control rate with gemcitabine, cisplatin, and nab-paclitaxel.