{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T02:55:49Z","timestamp":1792119349311,"version":"4.4.0"},"reference-count":13,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2025,5,31]],"date-time":"2025-05-31T00:00:00Z","timestamp":1748649600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,5,31]],"date-time":"2025-05-31T00:00:00Z","timestamp":1748649600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Tata Memorial Hospital - TMC"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Ann Surg Oncol"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Introduction<\/jats:title>\n            <jats:p>Radical resection remains the only curative option for intrahepatic cholangiocarcinoma (iCCA).<jats:sup>1\u20133<\/jats:sup> Patients with multifocal tumors, vascular invasion, or lymph node metastasis are considered to have locally advanced disease.<jats:sup>4<\/jats:sup> Neoadjuvant chemotherapy with gemcitabine and cisplatin as first line or with capecitabine and irinotecan as second line have shown oncological benefit.<jats:sup>5\u20138<\/jats:sup> More recently, Durvalumab has also showed benefit in addition to chemotherapy.<jats:sup>9<\/jats:sup> For tumours with major vascular invasion, stereotactic body radiation therapy (SBRT) is a safe treatment option where upfront surgery may not provide the desired oncological outcomes.<jats:sup>10\u201313<\/jats:sup> We present a video where combination of modalities was used to achieve downstaging followed by surgery.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Case<\/jats:title>\n            <jats:p>A 64-year-old male patient was diagnosed with locally advanced iCCA involving left lobe with left portal vein thrombosis, left hepatic vein (LHV) encasement, and middle hepatic vein (MHV) abutment. Cancer antigen (CA) 19-9 was 1890 U\/mL. After three cycles of gemcitabine and cisplatin, response computed tomography (CT) scan showed disease progression, and second-line chemotherapy with immunotherapy (capecitabine, irinotecan, durvalumab) was started with stereotactic body radiation therapy. Response CT showed significant size reduction. CA 19-9 dropped to 17 U\/mL. Patient was planned for left hepatectomy with portal vein resection (PVR) and segment 8 venous reconstruction.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Steps of Surgery<\/jats:title>\n            <jats:p>\n              <jats:list list-type=\"order\">\n                <jats:list-item>\n                  <jats:p>Kocherization, inter-aortocaval nodal sampling, and peri-portal dissection.<\/jats:p>\n                <\/jats:list-item>\n                <jats:list-item>\n                  <jats:p>Parenchymal transection with left hepatic duct division, PVR with primary repair<\/jats:p>\n                <\/jats:list-item>\n                <jats:list-item>\n                  <jats:p>Isolation of segment 8 vein, division distal to MHV-LHV confluence, specimen retrieval.<\/jats:p>\n                <\/jats:list-item>\n                <jats:list-item>\n                  <jats:p>Reconstruction of segment 8 vein to MHV-LHV confluence using polytetrafluoroethylene graft (PTFE). Final histopathology report revealed complete pathological response. Patient was planned for two more cycles of same chemotherapy followed by observation.<\/jats:p>\n                <\/jats:list-item>\n              <\/jats:list>\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Resection with periportal lymphadenectomy and negative margins remains the only curative option for iCCA. Multimodality options can be utilized to downstage tumor, and complex liver resection with vascular reconstruction can achieve excellent oncological outcomes.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1245\/s10434-025-17282-0","type":"journal-article","created":{"date-parts":[[2025,5,31]],"date-time":"2025-05-31T15:35:03Z","timestamp":1748705703000},"page":"6334-6335","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["A Multimodality Treatment Strategy for an Intrahepatic Cholangiocarcinoma and Complex Liver Resection with Vascular Reconstruction\u2014A Video Vignette"],"prefix":"10.1245","volume":"32","author":[{"given":"Niket","family":"Shah","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shraddha","family":"Patkar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gurudatt","family":"Varty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaival","family":"Gundavda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaurav","family":"Chaubal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahesh","family":"Goel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,5,31]]},"reference":[{"issue":"1","key":"17282_CR1","first-page":"7","volume":"71","author":"RL Siegel","year":"2021","unstructured":"Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2021. CA Cancer J Clin. 2021;71(1):7\u201333.","journal-title":"CA Cancer J Clin."},{"issue":"4","key":"17282_CR2","doi-asserted-by":"crossref","first-page":"270","DOI":"10.21037\/hbsn.2018.03.16","volume":"7","author":"EW Beal","year":"2018","unstructured":"Beal EW, Tumin D, Moris D, Zhang XF, Chakedis J, Dilhoff M, et al. Cohort contributions to trends in the incidence and mortality of intrahepatic cholangiocarcinoma. Hepatobiliary Surg Nutr. 2018;7(4):270.","journal-title":"Hepatobiliary Surg Nutr."},{"issue":"6","key":"17282_CR3","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1001\/jamasurg.2013.5137","volume":"149","author":"MN Mavros","year":"2014","unstructured":"Mavros MN, Economopoulos KP, Alexiou VG, Pawlik TM. Treatment and prognosis for patients with intrahepatic cholangiocarcinoma: systematic review and meta-analysis. JAMA Surg. 2014;149(6):565\u201374.","journal-title":"JAMA Surg."},{"issue":"2","key":"17282_CR4","doi-asserted-by":"crossref","first-page":"15","DOI":"10.21037\/cco-22-115","volume":"12","author":"L Bressler","year":"2023","unstructured":"Bressler L, Bath N, Manne A, Miller E, Cloyd JM. Management of locally advanced intrahepatic cholangiocarcinoma: a narrative review. Chin Clin Oncol. 2023;12(2):15.","journal-title":"Chin Clin Oncol."},{"issue":"1","key":"17282_CR5","doi-asserted-by":"crossref","first-page":"6","DOI":"10.14701\/ahbps.2020.24.1.6","volume":"24","author":"S Kamarajah","year":"2020","unstructured":"Kamarajah S, Giovinazzo F, Roberts KJ, Punia P, Sutcliffe RP, Marudanayagam R, et al. The role of down staging treatment in the management of locally advanced intrahepatic cholangiocarcinoma: review of literature and pooled analysis. Ann Hepatobiliary Pancreat Surg. 2020;24(1):6.","journal-title":"Ann Hepatobiliary Pancreat Surg."},{"issue":"1","key":"17282_CR6","doi-asserted-by":"crossref","DOI":"10.1016\/j.currproblcancer.2020.100614","volume":"45","author":"M Fruscione","year":"2021","unstructured":"Fruscione M, Pickens RC, Baker EH, Martinie JB, Iannitti DA, Hwang JJ, et al. Conversion therapy for intrahepatic cholangiocarcinoma and tumor downsizing to increase resection rates: a systematic review. Curr Probl Cancer. 2021;45(1):100614.","journal-title":"Curr Probl Cancer."},{"issue":"3","key":"17282_CR7","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1038\/s41416-018-0138-2","volume":"119","author":"Y Zheng","year":"2018","unstructured":"Zheng Y, Tu X, Zhao P, Jiang W, Liu L, Tong Z, et al. A randomised phase II study of second-line XELIRI regimen versus irinotecan monotherapy in advanced biliary tract cancer patients progressed on gemcitabine and cisplatin. Br J Cancer. 2018;119(3):291\u20135.","journal-title":"Br J Cancer."},{"issue":"5","key":"17282_CR8","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1038\/bjc.2016.446","volume":"116","author":"BJ Kim","year":"2017","unstructured":"Kim BJ, Yoo C, Kim K, Hyung J, Park SJ, Ryoo BY, et al. Efficacy of fluoropyrimidine-based chemotherapy in patients with advanced biliary tract cancer after failure of gemcitabine plus cisplatin: retrospective analysis of 321 patients. Br J Cancer. 2017;116(5):561\u20137.","journal-title":"Br J Cancer."},{"issue":"8","key":"17282_CR9","first-page":"EVIDoa2200015","volume":"1","author":"DY Oh","year":"2022","unstructured":"Oh DY, Ruth He A, Qin S, Chen LT, Okusaka T, Vogel A, et al. Durvalumab plus gemcitabine and cisplatin in advanced biliary tract cancer. NEJM Evidence. 2022;1(8):EVIDoa2200015.","journal-title":"NEJM Evidence."},{"issue":"5","key":"17282_CR10","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1111\/jgh.12843","volume":"30","author":"A Ohkawa","year":"2015","unstructured":"Ohkawa A, Mizumoto M, Ishikawa H, Abei M, Fukuda K, Hashimoto T, et al. Proton beam therapy for unresectable intrahepatic cholangiocarcinoma. J Gastroenterol Hepatol. 2015;30(5):957\u201363.","journal-title":"J Gastroenterol Hepatol."},{"issue":"10","key":"17282_CR11","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1007\/s00066-014-0714-1","volume":"190","author":"F Sterzing","year":"2014","unstructured":"Sterzing F, Brunner TB, Ernst I, Baus WW, Greve B, Herfarth K, et al. Stereotactic body radiotherapy for liver tumors. Strahlentherapie und Onkologie. 2014;190(10):872.","journal-title":"Strahlentherapie und Onkologie."},{"issue":"4","key":"17282_CR12","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1016\/j.bpg.2016.06.003","volume":"30","author":"AM Romero","year":"2016","unstructured":"Romero AM, de Man RA. Stereotactic body radiation therapy for primary and metastatic liver tumors: from technological evolution to improved patient care. Best Pract Res Clin Gastroenterol. 2016;30(4):603\u201316.","journal-title":"Best Pract Res Clin Gastroenterol."},{"key":"17282_CR13","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.canlet.2020.12.045","volume":"502","author":"NE Donlon","year":"2021","unstructured":"Donlon NE, Power R, Hayes C, Reynolds JV, Lysaght J. Radiotherapy, immunotherapy, and the tumour microenvironment: turning an immunosuppressive milieu into a therapeutic opportunity. Cancer Lett. 2021;502:84\u201396.","journal-title":"Cancer Lett."}],"container-title":["Annals of Surgical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1245\/s10434-025-17282-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1245\/s10434-025-17282-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1245\/s10434-025-17282-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T16:01:54Z","timestamp":1754150514000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1245\/s10434-025-17282-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,31]]},"references-count":13,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,9]]}},"alternative-id":["17282"],"URL":"https:\/\/doi.org\/10.1245\/s10434-025-17282-0","relation":{},"ISSN":["1068-9265","1534-4681"],"issn-type":[{"value":"1068-9265","type":"print"},{"value":"1534-4681","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,31]]},"assertion":[{"value":"5 February 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 March 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 May 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Nothing to disclose.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosures"}}]}}