Hepatic Resection and Transplantation for Peripheral Cholangiocarcinoma

Casavilla, F; Marsh, J. Wallis; Iwatsuki, Shunzaburo; Todo, Satoru; Lee, Randall G.; Madariaga, Juan; Pinna, Antonio D.; Dvorchik, Igor; Fung, John J.; Starzl, Thomas E.

doi:10.1016/s1072-7515(97)00088-4

Cited by 181 publications

(47 citation statements)

References 23 publications

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“…This remains controversial because others reported equivalent outcomes between patients with IH-CCC and EH-CCC. 16,17,22 This investigation found no significant difference in patient or disease-free survival between lesions arising from IH or EH bile ducts despite relative equivalency of tumor stage in both groups. Thus, we do not use tumor location as a selection determinant when considering LT for patients with CCC.…”

Section: Discussionmentioning

confidence: 64%

“…However, the allocation of limited donor organs to this patient population has been extremely controversial. In the literature, several centers reported the use of LT for patients with CCC 10,[17][18][19][20][21][22][23][24][25][26][27][28] with limited results because of high recurrence rates. The purpose of this study is to retrospectively review our experience with LT for patients with IH-CCC and EH-CCC to determine prognostic variables that may impact on patient selection and outcome.…”

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confidence: 99%

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Liver transplantation for cholangiocellular carcinoma: Analysis of a single-center experience and review of the literature

Shimoda

Farmer

Colquhoun

et al. 2001

Liver Transplantation

204

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Cholangiocellular carcinoma (CCC) is a biliary malignancy that frequently presents in advanced unresectable stages. The role of liver transplantation (LT) as a surgical modality is unclear. The goal of this study is to evaluate outcomes of patients with CCC undergoing LT. A retrospective analysis of all patients undergoing LT was undertaken. Only those patients with the pathological diagnosis of CCC were included on the study. Patients were divided into two groups based on primary tumor location: extrahepatic (EH)-CCC and intrahepatic (IH)-CCC. The Kaplan-Meier method was used to calculate overall and recurrence-free survival. Log-rank analysis was used to determine the significance of prognostic variables. Twenty-five patients were identified: 9 patients with EH-CCC (5 patients, Klatskin-type; 2 patients, the middle third; and 2 patients, the distal third) and 16 patients with IH-CCC. Mean age was 47.1 ؎ 10.6 years. There were 14 men and 11 women. Tumor stage was local (stages I and II; n ‫؍‬ 9) or advanced (stages III and IV; n ‫؍‬ 16). Overall and disease-free survival rates were 71% and 67% at 1 year and 35% and 32% at 3 years, respectively. Analysis of variables showed statistically significant improved outcomes (P < .05) for the absence of contiguous organ invasion at LT, small tumor size, and single tumor foci. This study indicates that early survival after LT for CCC is acceptable. Three-year disease-free survival is achieved in approximately 30% of patients. These outcomes can be improved by applying strict selection criteria based on prognostic variables identified in this study. (Liver Transpl 2001;7:1023-1033.)

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Section: Discussionmentioning

confidence: 64%

mentioning

confidence: 99%

Liver transplantation for cholangiocellular carcinoma: Analysis of a single-center experience and review of the literature

Shimoda

Farmer

Colquhoun

et al. 2001

Liver Transplantation

204

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“…The English-language literature on PCC has reported only a few long-term survivors, 10,23 and the 5-year survival rate after curative resection has been reported to be approximately 40%. [3][4][5][6][7][8][9]24 Compared with other series of PCC, the IG type had a much better prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…1 Because the lesion is advanced by the time of diagnosis, 2 the possibility of surgical resection is limited and the prognosis is generally poor. [3][4][5][6][7][8][9] In 1992, Yamamoto et al 10 classified PCC into 2 types, mass-forming (MF) and periductal-infiltrating (PI), and showed their different clinical behaviors. The MF type creates an apparent lesion in the liver, with frequent remnant hepatic recurrence after resection.…”

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confidence: 99%

Clinicopathologic features of the intraductal growth type of peripheral cholangiocarcinoma

et al. 2000

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The clinicopathologic features of the intraductal growth (IG) type of peripheral cholangiocarcinoma (PCC) were examined retrospectively. Out of 112 patients who underwent surgery for PCC at Seoul National University Hospital, Seoul, Korea, between January 1980 and December 1997, 16 were classified as having the IG type. Thirteen were men and 3 were women. Their ages ranged from 38 to 73 years with a mean age of 55.9 years. Abdominal pain was the most common symptom and jaundice was found in 18.8%. Five patients had associated clonorchiasis and 6 patients experienced hepatolithiasis. Tumor sizes ranged from 0.5 cm to 14.0 cm with a mean of 4.3 cm. The tumor was located in the right lobe in 7 cases and the left lobe in 9 cases. Thirteen patients underwent major hepatic resection, and 3 underwent minor resection, involving a subsegmentectomy. Mucin was found in the bile in 4 cases. Pathology showed papillary adenocarcinoma with a background of adenomatous hyperplasia, and the absence of lymph node metastasis in all cases. The tumors were confined to the mucosa in 5 cases. Out of the 16 hepatic resections, 1 was palliative due to a positive margin. In 2 of the patients who underwent minor resections, recurrences developed, and 1 of these died 56 months after resection. Out of the 16 patients, 15 remain alive, ranging from 1 to 13 years, postoperatively. In conclusion, the IG type of PCC should be distinguished from other types of PCC because a favorable prognosis can be expected after complete surgical resection. (HEPATOLOGY 2000;31:12-17.)Intrahepatic or peripheral cholangiocarcinoma (PCC), a primary adenocarcinoma of the liver originating from the intrahepatic bile ducts (IHD), is the second most common primary hepatic malignancy, next to hepatocellular carcinoma. 1 Because the lesion is advanced by the time of diagnosis, 2 the possibility of surgical resection is limited and the prognosis is generally poor. [3][4][5][6][7][8][9] In 1992, Yamamoto et al. 10 classified PCC into 2 types, mass-forming (MF) and periductal-infiltrating (PI), and showed their different clinical behaviors. The MF type creates an apparent lesion in the liver, with frequent remnant hepatic recurrence after resection. The PI type causes a stricture or an obstruction of the IHD without forming a definite mass in the liver. It spreads along the Glisson' s capsule and metastasizes to the hilar lymph nodes. Later, another type, intraductal growth (IG), was added. 11 This type of tumor shows a papillary growth into the lumen of the bile duct. 12 There have been a few scattered reports about the clinical and pathological features of the IG type of PCC. 13,14 Here, we describe the clinical and pathological features of the IG type of PCC in 16 patients who underwent surgical resection at

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“…However, disease incidence steadily increased in both Japan and worldwide, and carries with it a high mortality rate [1][2][3]. Curative surgical treatment is considered the only real effective treatment [4][5][6][7], and many surgeons have recommended aggressive surgical treatment, including major hepatectomy and extended systematic lymph node (LN) dissection with or without extra hepatic bile duct resection for improving surgical outcomes [4][5][6][7][8][9][10]. However, to date, extended surgical treatment has not overcome IHCC malignant behavior, such as aggressive tumor spread into lymph or vascular vessels, hence the high recurrence rate, even if macroscopic curative resection is achieved [8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

The value of systematic lymph node dissection for intrahepatic cholangiocarcinoma from the viewpoint of liver lymphatics

Morine

Shimada

2015

J Gastroenterol

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Lymph node (LN) metastasis from intrahepatic cholangiocarcinoma (IHCC) might be one of the most important indicators of aggressive surgical resection, yet the value of LN dissection is still controversial. To address this clinical problem, we need to better understand the multidirectional lymphatic outflow from the liver. Although most hepatic lymph flows into the hilar LNs along portal triads, there are also several lymphatic outflows directly communicating with distant areas or the general lymphatic system. Moreover, it has been revealed that LN metastasis spreads to more distal LNs through the hepatoduodenal ligament or other multidirectional lymphatic pathways connected to the general lymphatic system. Therefore, systematic LN dissection might merely be LN sampling in IHCC with LN metastasis. A multidisciplinary strategy focusing on adjuvant treatment after surgery is immediately necessary in these cases. In IHCC without LN metastasis, the accuracy of preoperative imaging assessment of LN metastasis is unsatisfactory and useless for detecting metastatic LNs in clinical settings. Therefore, prophylactic systematic LN dissection for IHCC without preoperative LN swelling is recommended for accurate LN status assessment and reduction of local recurrences. However, this procedure might not offer any clinical benefit according to the results of retrospective comparative studies. In this review, we summarize previous reports regarding lymphatic outflow of the liver and discuss LN dissection for IHCC.

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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).

Cited by 181 publications

References 23 publications

Liver transplantation for cholangiocellular carcinoma: Analysis of a single-center experience and review of the literature

Liver transplantation for cholangiocellular carcinoma: Analysis of a single-center experience and review of the literature

Clinicopathologic features of the intraductal growth type of peripheral cholangiocarcinoma

The value of systematic lymph node dissection for intrahepatic cholangiocarcinoma from the viewpoint of liver lymphatics

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