Liver Transplantation for Cholangiocarcinoma: Insights into the Prognosis and the Evolving Indications

Panayotova, Guergana G.; Paterno, Flavio; Guarrera, James V.; Lunsford, Keri E.

doi:10.1007/s11912-020-00910-1

Cited by 10 publications

(19 citation statements)

References 67 publications

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“…Due to the locally-aggressive growth pattern and late presentation as well as concerns for adequate future liver remnant (FLR) function and proximity to vital structures, an oncologic resection is only possible for approximately 20% of patients [ 1 , 9 , 10 ]. For unresectable disease, data from the multicenter phase III ABC-02 trial for treatment of advanced biliary tract cancers demonstrate a median overall patient survival of only 9.6 months, despite best medical therapy with gemcitabine and cisplatin [ 11 , 12 ]. Liver transplantation (LT) is emerging as an alternative treatment for select patients with favorable tumor biology.…”

Section: Introductionmentioning

confidence: 99%

“…Liver transplantation (LT) is emerging as an alternative treatment for select patients with favorable tumor biology. Transplantation offers the advantage of the widest margins of resection, treatment of underlying liver disease, and obviates the concern for FLR function [ 12 ]. However, in this era of persistent donor organ shortage, concerns for cancer recurrence, related mortality, and resource allocation have limited the wide application of LT for the treatment of intrahepatic cholangiocarcinoma.…”

Section: Introductionmentioning

confidence: 99%

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The Role of Surgical Resection and Liver Transplantation for the Treatment of Intrahepatic Cholangiocarcinoma

Panayotova

Guerra

Guarrera

et al. 2021

JCM

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Intrahepatic cholangiocarcinoma (iCCA) is a rare and complex malignancy of the biliary epithelium. Due to its silent presentation, patients are frequently diagnosed late in their disease course, resulting in poor overall survival. Advances in molecular profiling and targeted therapies have improved medical management, but long-term survival is rarely seen with medical therapy alone. Surgical resection offers a survival advantage, but negative oncologic margins are difficult to achieve, recurrence rates are high, and the need for adequate future liver remnant limits the extent of resection. Advances in neoadjuvant and adjuvant treatments have broadened patient treatment options, and these agents are undergoing active investigation, especially in the setting of advanced, initially unresectable disease. For those who are not able to undergo resection, liver transplantation is emerging as a potential curative therapy in certain cases. Patient selection, favorable tumor biology, and a protocolized, multidisciplinary approach are ultimately necessary for best patient outcomes. This review will discuss the current surgical management of locally advanced, liver-limited intrahepatic cholangiocarcinoma as well as the role of liver transplantation for select patients with background liver disease.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Role of Surgical Resection and Liver Transplantation for the Treatment of Intrahepatic Cholangiocarcinoma

Panayotova

Guerra

Guarrera

et al. 2021

JCM

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“…Surgery is the only potentially curative treatment for all anatomical subtypes of CCA, either in the form or resection or OLT with or without neoadjuvant or adjuvant therapy, which is mainly offered in highly selected patients with early stage PHCCA[ 10 , 11 , 98 , 117 , 148 ]. Overall, the prognosis of CCA is dismal, with an overall survival of 12-16 mo, without surgical treatment[ 10 , 149 ], while long-term survival is rare with medical therapy alone, owing to the paucity of effective medical and locoregional therapies[ 12 , 150 ]. In the setting of PSC, historically and in the pre-transplant era, most patients succumbed to complications of cirrhosis, while most recently CCA appears to be the leading cause of deaths for the general PSC population (58%)[ 22 , 151 ], as well as for those on a transplant waiting list[ 22 ].…”

Section: Treatment and Outcomesmentioning

confidence: 99%

“…CCA is a complex and aggressive disease and, particularly in the context of significant underlying disease as is PSC, warrants collaboration of specialists from different fields, including HPB and liver transplant surgeons, radiologists, hepatologists, medical oncologists, radiation oncologists, interventional radiologists, gastroenterologists, endoscopists and pathologists[ 150 , 155 ].…”

Section: Treatment and Outcomesmentioning

confidence: 99%

“…Notably, the ongoing prospective, randomised, multicenter “TRANSPHILL” study which aims to compare OLT with neoadjuvant radiochemotherapy vs standard of care liver and bile duct resection for PHCCA, lists PSC among the exclusion criteria[ 163 ]. Even though LRs in the context of PSC are largely discouraged, some authors accept that for a subset of patients who may present with surgically resectable CCA in the absence of advanced hepatic fibrosis and candidacy for transplant, an attempt at surgical resection should be considered[ 4 , 150 , 154 , 156 ]. Furthermore, in 2008, a retrospective study from Birmingham in the UK (where CCA is still not an accepted indication for OLT[ 22 ]), reported good outcomes with 7 major LRs and 1 Local excision of the extrahepatic biliary tree, for PSC-associated CCA.…”

Section: Treatment and Outcomesmentioning

confidence: 99%

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Review of incidence and outcomes of treatment of cholangiocarcinoma in patients with primary sclerosing cholangitis

Saffioti

Mavroeidis

2021

WJGO

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Primary sclerosing cholangitis (PSC) is a premalignant condition and a well-documented risk factor for cholangiocarcinoma (CCA) which is the most common malignancy in this setting and the leading cause of deaths in the recent years, with an increasing incidence. PSC-associated CCA has a geographical distribution that follows the incidence of PSC, with an observed ascending gradient from the Eastern to the Western and from the Southern to the Northern countries. It may arise at any location along the biliary tree but is most common in the perihilar area. Patients with PSC and intrahepatic or perihilar CCA are typically not suitable for liver resection, which is otherwise the treatment of choice with curative intent in patients with resectable tumours, providing a radical resection with clear margins can be achieved. This largely relates to the commonly advanced stage of liver disease at presentation, which allows consideration for liver resection only for a very limited number of suitable patients with PSC. On the other hand, remarkable progress has been reached in the last decades with the implementation of a protocol combining neoadjuvant chemoradiation and orthotopic liver transplantation (OLT) for the treatment of perihilar CCA, within specific criteria. Excellent results have been achieved particularly for PSC patients with this cancer, who seem to benefit the most from this treatment, having converted this into an accepted indication for transplantation and the standard of care in several experienced centres. Intrahepatic CCA as an indication for OLT remains controversial and has not been accepted given disappointing previous results. However, as recent studies have shown favourable outcomes in early intrahepatic CCA, it may be that under defined criteria, OLT may play a more prominent role in the future. Distal CCA in the context of PSC requires aggressive surgical treatment with curative intent, when feasible. This review provides insight about particular features of CCA in the setting of PSC, with a main focus on its incidence, considerations relating to its anatomical location and implications to treatment and outcomes, through the viewpoint of historical evolution of management, and future perspectives.

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New challenges in cholangiocarcinoma candidates for elective surgery: harnessing the microbiome dysbiosis

López-López

Balaguer-Román

et al. 2023

Langenbecks Arch Surg

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Liver Transplantation for Cholangiocarcinoma: Insights into the Prognosis and the Evolving Indications

Cited by 10 publications

References 67 publications

The Role of Surgical Resection and Liver Transplantation for the Treatment of Intrahepatic Cholangiocarcinoma

The Role of Surgical Resection and Liver Transplantation for the Treatment of Intrahepatic Cholangiocarcinoma

Review of incidence and outcomes of treatment of cholangiocarcinoma in patients with primary sclerosing cholangitis

New challenges in cholangiocarcinoma candidates for elective surgery: harnessing the microbiome dysbiosis

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