Long-Term Survival After Conversion Surgery and Multidisciplinary Therapy in a Case of Initially Unresectable Intrahepatic Cholangiocarcinoma

A 66-year-old woman was referred to our hospital for investigation of a 10 cm liver tumor located in the right hepatic lobe.She was diagnosed with intrahepatic cholangiocarcinoma based on a liver biopsy.Preoperative imaging strongly suggested peritoneal dissemination and para-aortic lymph node metastases.Considering the possibility of conversion surgery, the patient underwent nine cycles of systemic chemotherapy, which markedly reduced the size of the tumor.Subsequent staging laparoscopy confirmed the absence of residual peritoneal dissemination, and right hepatectomy with lymphadenectomy was performed.Fifteen months after surgery, metastatic recurrence was detected in the right lung, followed by recurrence in the left lung at 33 months.Pulmonary metastasectomy was performed for both lesions.Although adjuvant chemotherapy has been continued, the patient remains alive without evidence of recurrence at 60 months after initial presentation.Recent advances in systemic chemotherapy may provide prolonged survival for selected patients with initially unresectable and/or metastatic cholangiocarcinoma.