Multimodal treatment of an advanced intrahepatic cholangiocarcinoma and its recurrence – a case report

Introduction: Intrahepatic cholangiocarcinoma (ICC) is rare and often diagnosed in an advanced stage. Neoadjuvant therapy is not established and data on its value are in palliative intention. In the case of a recurrence patients often are offered systemic chemotherapy as the only treatment option. We report on a patient with advanced intrahepatic cholangiocarcinoma who underwent multimodal treatment leading to a long-term survival. Case report: A 61-year-old woman presented with an advanced intrahepatic cholangiocarcinoma of the right liver lobe without evidence of metastatic spread. She had already completed two cycles of chemotherapy of Cisplatin and Gemcitabine resulting in stable disease. An extended hemihepatectomy of the right lobe including segments I, IVa and partially IVb was performed. The TNM status (8th edition) was pT2b (3), pN0 (0/6), M0, V1, G2 and R0. Ten months later recurrence was diagnosed and treated with microwave ablation. Recurrence occurred again and the patient underwent repeated resection 22 months after primary resection. After detection of repeated recurrence once more, repeated resection was performed 46 months after initial resection. The patient is still alive and tumor-free 7 years after primary resection. Conclusion: Multimodal treatment including preoperative chemotherapy, complete resection and repeated resection of recurrence as well as microwave ablation led to long-term survival in a case of advanced intrahepatic cholangiocarcinoma. Close follow-ups were crucial to offer the best treatment options.