Introduction : Perihilar cholangiocarcinoma (PHCC) has been reported to have a high locoregional recurrence after surgical resection. We attempted to demonstrate the necessity of neoadjuvant treatment for PHCC by investigating recurrence patterns between PHCC and distal cholangiocarcinoma (DCC) and explore neoadjuvant concurrent chemoradiotherapy (NAT)’s benefits in the treatment of locally advanced PHCC.

Methods : First, we compared recurrence patterns after R0 resection in patients with PHCC (n=204) or DCC (n=258). Second, patients who underwent curative-intent resection of PHCC (n=132) were divided into NAT group, comprising those who received NAT before surgery (n=28), and upfront resection group (n=104). Perioperative outcomes were compared between the two groups, and prognostic factors for overall survival (OS) were evaluated. Surgery-related recurrence (SRR) was defined as recurrence in the locoregional lymph nodes, anastomosis site, resection margin, and peritoneal seeding.

Results : The PHCC group showed significantly more frequent SRR than the DCC group (31.4% vs 17.1%, P<.001). More R0 resection was achieved in the NAT group than in the resection group (92.9% vs 73.1%, P=.027), and there was less SRR (14.3% vs 45.4%, P=.008). Two groups showed comparable disease-free survival (NAT vs resection, 19.0 vs 15.0 months, P=.561) or OS (34.1 vs 27.1, P=.651). R0 resection, initial carbohydrate antigen 19-9 levels >400 U/mL, bilirubin levels >3 mg/dL, and tumor differentiation were independent prognostic factors for OS.

Conclusions : PHCC showed more frequent SRR than DCC, and NAT in locally advanced PHCC provided higher R0 resection and lower SRR rate than the resection group. These findings should be further investigated in a well-designed prospective study