Management evolution of intrahepatic cholangiocarcinoma in the last decade: real life high-volume center analysis

Introduction and Aim of the Study: Intrahepatic cholangiocarcinoma (ICC) is a rare and aggressive malignant tumor originating from the intrahepatic bile ducts or the intrahepatic stem cells. This cancer has an increasing incidence. The only potentially curative treatment for non-metastatic stages is surgical resection. Due to the rarity of this disease, designing prospective studies is complex. Therefore, a large multicentric study is currently underway, collecting data from leading centers worldwide, ranging from Japan to Europe and the United States, with the aim of assessing the evolution of ICC treatment. Our center will also participate in the study, and with the data collected, we aim to assess the evolution of ICC treatment within our cohort of patients diagnosed between 2009 and 2021. Materials and Methods: We selected patients, with diagnosis of ICC between January 1st, 2009, and December 31st, 2021, that were treated at Complex Operating Unit of General Surgery 2 - Hepatobiliopancreatic Surgery and Liver Transplantation of the Azienda Ospedale - University of Padua. These patients had single or multifocal ICC limited to the liver, with possible lymph node involvement but no distant metastasis (AJCC 8th edition TXNXM0). Patients with perihilar or distal ICC, hepatocellular-cholangiocarcinoma, and those with other concomitant malignancies were excluded. We divided the patients into three cohorts based on the year of diagnosis: 2009-2013, 2014-2017, and 2018-2021. We analyzed demographic variables, cancer- and surgical-associated variables, and systemic and locoregional treatments. OS, DFS, and recurrence rate were assessed. Results: We did not observe significant differences in OS and DFS among the different groups, however there is a trend towards a better OS and DFS in the latter group (2018-2021). We found no significant differences in therapeutic strategies, but we noted an initial trend, particularly regarding the use of systemic therapy, in adjuvant or neoadjuvant regimen, and the choice of surgical technique. Regarding the latter, there is a tendency towards less invasive techniques such as laparoscopy or robotic surgery, with less extensive resections and reduced post-operative complications. As for the former, there is an increasing percentage of patients receiving systemic therapy, particularly in adjuvant settings but also neoadjuvant, alongside surgery. Conversely, strategies involving liver-directed therapies such as TACE and TARE are declining. Conclusions: In conclusion, surgery remains, to date, the only potentially curative treatment for non-metastatic ICC. Even when combined with systemic treatments, statistically significant increases in DFS or OS have not been demonstrated over the last decades. We are aware that due to the small sample size of our study, obtaining significant results is challenging, but we are confident that these will be achieved through the international multicentric study in which our center is participating.