Outcomes following exploratory surgery without subsequent resection in perihilar cholangiocarcinoma: A nationwide analysis

Introduction: Definitive assessment of resectability in perihilar cholangiocarcinoma (pCCA) often requires surgical exploration. Limited data exist on whether surgical exploration without resection affects the chance of receiving subsequent systemic therapy and survival. This nationwide analysis aims to address this question. Methods: Patients diagnosed with non-metastatic pCCA between 2012 and 2023 were selected from the Netherlands Cancer Registry and categorized as resected, explored (surgical exploration without resection), or non-explored (non-metastatic tumours without exploration or resection). Overall survival data was stratified by systemic therapy use. Results: The cohort included 2014 patients of which 490 patients (24.3 %) underwent resection, 258 patients (12.8 %) underwent surgical exploration without resection, and 1266 patients (62.9 %) were not explored. Overall, 90-day mortality following exploration was 19.5 %. Among explored patients, 38.0 % (98/258) received systemic therapy compared to 10.6 % (134/1266) of non-explored patients (p < 0.001). With systemic therapy, explored patients had a median overall survival (mOS) of 14.3 months (95 % CI 12.7–18.2) from diagnosis compared to 12.8 months (95 % CI 11.6–15.8) for non-explored patients (p = 0.350). With best supportive care, explored patients had a mOS of 8.1 months (95 % CI 6.5–10.3) compared to 3.2 months (95 % CI 2.8–3.7) for non-explored patients (p ≤ 0.001). Conclusion: Among patients with non-metastatic pCCA receiving systemic therapy, survival outcomes are comparable between those who undergo surgical exploration and those who do not. Despite a possible impact on quality of life, these findings suggest that surgical exploration does not hinder access to systemic therapy or negatively affect survival.