To explore the integration of immunotherapy into hepatobiliary surgery and its implications for surgical timing, immune monitoring, and recurrence mitigation.
Approach:
Introduction: Discusses the evolving role of immunotherapy in determining surgical resectability for hepatobiliary cancers.
Immuno-surgical resectability: Proposes a new concept of immuno-surgical resectability that considers immune-related factors alongside traditional anatomical assessments.
Surgical timing and transplantation: Examines the importance of timing in surgery relative to immunotherapy and the specific considerations for transplant candidates.
Key Findings:
Immune checkpoint inhibitors (ICIs) and other immunotherapies can influence surgical decisions and outcomes in hepatobiliary cancers.
Surgical timing must balance the risks of early surgery against the potential for resistant disease if delayed.
Pre-transplant ICI exposure requires careful management of washout periods to minimize rejection risks.
Interpretation:
Limitations:
Current evidence for adjuvant immunotherapy in biliary tract cancers is not yet conclusive.
The proposed immuno-surgical resectability concept requires further validation across different tumor types.
