Multidisciplinary treatment with conversion surgery after radiological complete response of liver metastasis to gemcitabine, cisplatin, and durvalumab in metastatic distal cholangiocarcinoma.
Atsushi Tomioka, Nao Kawaguchi, Mitsuaki Ishida et al.
✦ AI-curated · Sources linked
Case in brief
A 73-year-old woman with prior total gastrectomy was diagnosed with distal cholangiocarcinoma and a solitary liver metastasis. After endoscopic ultrasound-guided hepaticojejunostomy and eight cycles of gemcitabine, cisplatin, and durvalumab, imaging showed complete response of the liver lesion, while the primary tumor remained. Following 16 cycles of durvalumab maintenance, she underwent conversion pancreaticoduodenectomy without hepatectomy. Pathology showed residual viable tumor, staged ypT2N2M0. She was recurrence-free 15 months after surgery.
What made this case unusual
The metastatic lesion had a radiological complete response while viable primary tumor persisted, prompting conversion surgery without resection of the liver site. Immunohistochemistry also suggested differing immune microenvironments in the primary and metastatic tumors.
Diagnostic / clinical pearl
Radiological response may differ between the primary tumor and metastasis; in this case, persistent primary disease remained despite complete radiological response of the liver lesion.
Why it matters
The case illustrates that multidisciplinary conversion surgery may be considered in selected patients with metastatic distal cholangiocarcinoma whose disease remains controlled after chemo-immunotherapy.