Hepatic resection and transplantation for peripheral cholangiocarcinoma

Abstract

Background: Recent publications have questioned the role of orthotopic liver transplantation (OLT) in treating advanced or unresectable peripheral cholangiocarcinoma (Ch-Ca).

A new staging system for mass-forming intrahepatic cholangiocarcinoma

“…26 -28 Because the rates of viral infection for the general population in the same age groups in Japan reportedly are 1.1-3.0% for HCV 29 and 1.8% for HBV, 30 the current results suggest that some percentage of mass-forming ICC may arise from a virus-infected liver. The current overall 5-year survival rate of 29%, including an in-hospital mortality rate of 5%, was comparable to 6,9,11,12,21 or worse than 10,15,16 the rates in other reports. This may be due to the criteria for patient recruitment, because, in the latter studies, patients with perihilar carcinoma, which involves the major bile duct, were excluded; thus, there was no combined resection of the hepatic duct confluence.…”

“…11,12,[15][16][17] This feature indicates an aggressive tumor biology and independently affects postresection survival. It is interesting to note that the number of tumors was not related to the presence of vascular invasion in this series: Seven of 19 patients (37%) without vascular invasion and 21 of 41 patients (51%) with vascular invasion had multiple tumors (P ϭ 0.30; chi-square test).…”

“…4 Recently, several reports have described the clinicopathologic features and surgical outcome of patients suffering from ICC. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] However, due to the limited numbers of patients who undergo resection at a single institute, a thorough investigation of ICC involving an analysis of clinicopathologic factors has not been reported.…”

Resektion und Transplantation bei Lebertumoren

“…Auch durch eine radikale Erweiterung des Resektionsausmaßes bei der Transplantation im Sinne einer multiviszeralen Resektion (Oberbauchexenteration) kann die Rezidivrate nicht wesentlich gesenkt werden. Bei gleichen Überlebensraten ist dieses Vorgehen aber mit einer erheblichen perioperativen Mortalität und auch langfristigen Morbidität verbunden [6].…”

Tumor diagnosis in the adult liver transplant candidate

“…There has been controversy as to the role of transplantation in cholangiocarcinoma. Some authors believe that transplantation should be avoided in cholangiocarcinoma [45]; others limit the indication of transplantation in CC to single resectable lesion without lymph node involvement [46]; and others go to further radical operations such as combined pancreatoduodenectomy and liver transplantation in an attempt to eradicate the entire biliary tract without dissecting the hepatoduodenal ligament [47].…”