Received: 26 September 2016 | Revised: 30 October 2016 | Accepted: 21 November 2016 DOI 10.1002/jso.24524 RESEARCH ARTICLE The effect of preoperative chemotherapy treatment in surgically treated intrahepatic cholangiocarcinoma patients—A multi-institutional analysis Stefan Buettner 1,2 | Bas Groot Koerkamp 2 | Aslam Ejaz 1 | Florian E. Buisman 2 | Yuhree Kim 1 | Georgios Antonios Margonis 1 | Sorin Alexandrescu 3 | Hugo P. Marques 4 | Jorge Lamelas 4 | Luca Aldrighetti 5 | T. Clark Gamblin 6 | Shishir K. Maithel 7 | Carlo Pulitano 8 | Todd W. Bauer 9 | Feng Shen 10 | George A. Poultsides 11 | J. Wallis Marsh 12 | Jan N.M. IJzermans 2 | Timothy M. Pawlik 1 1 Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland 2 Department of Surgery, Erasmus Medical Center, Rotterdam, the Netherlands 3 Fundeni Clinical Institute, Bucharest, Romania 4 Curry Cabral Hospital, Lisbon, Portugal 5 Ospedale San Raffaele, Milan, Italy 6 Medical College of Wisconsin, Milwaukee, Wisconsin 7 Emory University, Atlanta, Georgia 8 University of Sydney, Sydney, Australia 9 University of Virginia, Charlottesville, Virginia 10 Eastern Hepatobiliary Surgery Hospital, Shanghai, China 11 Stanford University, Stanford, California 12 University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania Correspondence Timothy M. Pawlik, MD, MPH, PhD, FACS, Professor and Chair, Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Suite 670, Columbus, OH 43210. Email: tim.pawlik@osumc.edu INTRODUCTION: While preoperative chemotherapy (pCT) is utilized in many intra-abdominal cancers, the use of pCT among patients with intrahepatic cholangiocarcinoma (ICC) remains ill defined. As such, the objective of the current study was to examine the impact of pCT among patients undergoing curative-intent resection for ICC. METHODS: Patients who underwent hepatectomy for ICC were identified from a multi- institutional international cohort. The association between pCT with peri-operative and long- term clinical outcomes was assessed. RESULTS: Of the 1 057 patients who were identified and met the inclusion criteria, 62 patients (5.9%) received pCT. These patients were noticed to have more advanced disease. Median OS (pCT:46.9 months vs no pCT:37.4 months; P = 0.900) and DFS (pCT: 34.1 months vs no pCT: 29.1 months; P = 0.909) were similar between the two groups. In a subgroup analysis of propensity-score matched patients, there was longer OS (pCT:46.9 months vs no pCT:29.4 months) and DFS (pCT:34.1 months vs no pCT:14.0 months); however this did not reach statistical significance (both P > 0.05). CONCLUSION: In conclusion, pCT utilization among patients with ICC was higher among patients with more advanced disease. Short-term post-operative outcomes were not affected by pCT use and receipt of pCT resulted in equivalent OS and DFS following curative-intent resection. KEYWORDS intrahepatic cholangiocarcinoma, preoperative chemotherapy, prognostic factors, risk factors, survival 1 | INTRODUCTION Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver malignancy, accounting for 3% of all cases of gastro- intestinal cancer. 1,2 ICC makes up about 5-10% of all cholangiocarci- nomas and originates from bile ducts within the liver parenchyma. 2,3 Histologically, the majority of advanced ICC tumors are adenocarci- noma, which are typically treated with a combination of cytotoxic nucleoside analogs and platins. 4,5 When feasible, complete surgical resection of ICC remains the only possible option for cure with an estimated median survival ranging from 27 to 36 months. 6–9 However, only a minority of patients with ICC present with surgically resectable 312 | © 2017 Wiley Periodicals, Inc. wileyonlinelibrary.com/journal/jso J Surg Oncol 2017; 115: 312–318