Evolving patterns of adjuvant chemotherapy and survival after surgery for peri-hilar cholangiocarcinoma: results from the UK nationwide CAPBIL study.

Abstract

Peri-hilar cholangiocarcinoma (pCCA) is an aggressive adenocarcinoma of the biliary confluence that is associated with adverse prognosis. Although surgery is curative in intent, poor overall survival and high recurrence rates have been reported1,2. A lack of standardized adjuvant therapy could be a contributing factor. The BILCAP trial, which included 128 (28.6%) patients with pCCA, showed that adjuvant capecitabine improved overall survival in resected CCA3. As a consequence, adjuvant chemotherapy has been incorporated into guidelines4. This UK multicentre study reports contemporary real-world data on survival with resectable pCCA and assessed the impact of the BILCAP trial on the use of adjuvant chemotherapy. Prognostic factors for short- and long-term outcomes were also determined. Study methods are presented in Supplementary Materials. During the study period, 450 patients underwent liver resection with curative intent for pCCA in 22 UK centres (Fig. S1), with a median follow-up of 24 (i.q.r. 13–42) months (Table S1). Major complications (Clavien–Dindo (CD)=IIIa) occurred in 181 (40.2%) patients. The 90-day mortality rate was 12.0