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Impact of neoadjuvant chemotherapy on postoperative outcomes in intrahepatic cholangiocarcinoma: A propensity-matched analysis
Journal article   Peer reviewed

Impact of neoadjuvant chemotherapy on postoperative outcomes in intrahepatic cholangiocarcinoma: A propensity-matched analysis

Faisal S. Jehan, Ana McCracken, Aida Vanderpuye, Kathryn Wittrock, Kyle W. Freischlag and Hassan Aziz
The American journal of surgery, Vol.260, 117124
10/01/2026
DOI: 10.1016/j.amjsurg.2026.117124
PMID: 42372619

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Abstract

Neoadjuvant chemotherapy (NAC) is increasingly utilized in the management of intrahepatic cholangiocarcinoma (IHC), yet its impact on postoperative outcomes remains unclear. This study evaluates the surgical outcomes of hepatectomy following NAC compared to upfront resection in patients with IHC. We analyzed data from the ACS-NSQIP database (2019–2021), including all patients who underwent hepatectomy for IHC. The patients were stratified into two groups: those who received NAC and those who underwent upfront resection. Outcomes were assessed separately for minor and major hepatectomy. The primary outcomes were 30-day mortality and liver-specific complications, including bile leakage and post-hepatectomy liver failure (PHLF). The secondary outcomes included overall complications. Propensity score matching using nearest-neighbor methodology was performed to ensure balanced comparisons. A total of 1317 patients underwent hepatectomy for IHC. Overall, 285 patients (21.6%) received NAC. After propensity score matching, in major hepatectomy, patients who received NAC had no significant differences in mortality (2.6% vs. 3.6%, p = 0.70) or bile leakage (17.8% vs. 20.6%, p = 0.69) compared with those who underwent upfront surgery. However, NAC was associated with a significantly higher incidence of PHLF (19.1% vs. 10.3%; p = 0.01). Similarly, in minor hepatectomy, NAC was not associated with differences in mortality (2.2% vs. 2.7%, p = 0.92) or bile leakage (11% vs. 7.7%, p = 0.06) but was associated with an increased risk of PHLF (8.8% vs. 2.3%, p = 0.01). Approximately one in five patients undergoing hepatectomy for IHC received NAC. While NAC was not associated with increased mortality or overall complications, it was associated with a significantly higher risk of post-hepatectomy liver failure in both major and minor hepatectomies. These findings highlight the need for careful patient selection and perioperative optimization in patients undergoing liver resection after NAC. •Neoadjuvant chemotherapy (NAC) is used in ∼22% of patients undergoing hepatectomy for intrahepatic cholangiocarcinoma but does not increase 30-day mortality or bile leak rates compared with upfront surgery.•NAC is associated with a significantly higher risk of post-hepatectomy liver failure (PHLF) in both major and minor hepatectomies.•Findings underscore the importance of careful patient selection and perioperative optimization when planning liver resection after NAC.

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