Orthotopic liver transplantation after extended bile duct resection as treatment of hilar cholangiocarcinoma First long-terms results

Abstract

Although the surgical treatment of hilar cholangiocarcinoma represents the only potentially curative option, survival figures remain low over the long term. After hilar and partial hepatic resections for hilar cholangiocarcinoma, loco-regional tumor recurrence appears as the primary site of failure. From April 1992 to April 1996, 14 patients underwent extended bile duct resections. Extended bile duct resections combine total hepatectomy, partial pancreatoduodenectomy, and liver transplantation in an attempt to eradicate the entire biliary tract without dissecting the hepatoduodenal ligament. The postoperative 60-day mortality rate was 14% (n = 2). The rate of curative resections was 93% (13 of 14 extended bile duct resections). One- and 4-year survival rates after curative resections were 56% and 30%, respectively. The rate of curative resections increased by combining total hepatectomy, partial pancreatoduodenectomy, and liver transplantation, i.e., extended bile duct resection. However, survival figures have not improved accordingly. Therefore, this extended surgical procedure has to be implemented with caution and possibly not without modifications (e.g., multimodal treatment).

Predictors of Disease Recurrence Following Neoadjuvant Chemoradiotherapy and Liver Transplantation for Unresectable Perihilar Cholangiocarcinoma

“…Although earlier experiences with liver transplantation alone for CCA were uniformly disappointing (2,3,(7)(8)(9)(10)(11)(12), we developed a protocol for treatment of unresectable hilar CCA combining external beam radiation therapy (EBRT) with brachytherapy, 5-FU chemosensitization, followed by liver transplantation (13,14). Our initial experience was encouraging, and our most recent publication compared outcomes of 38 patients undergoing OLT for unresectable hilar CCA versus those who underwent resection of hilar CCA at our same institution and found transplantation to provide excellent outcomes with 82% five-year survival after transplantation versus 21% five-year survival after resection.…”

Liver transplantation for cholangiocarcinoma

“…The rationale to consider liver transplantation has included the idea that this approach would overcome the barriers of vascular tumour encasement, the presence of underlying liver disease, the risk of inadequate future remnant liver volume (FRLV) and finally the possibility of positive margin after resection. Unfortunately, this initial enthusiasm has been damped in view of early recurrence rate in up to 50% of the cases, and low 5-year survival rates ranging from 15 to 30% [2,3]. This led clinicians to abandon liver transplantation as a viable option for cholangiocarcinoma in most centres.…”

Lebertransplantation beim hilären Cholangiokarzinom

“…Die Berliner Gruppe berichtete von 4JÜR von ca. 30% nach einer Pankreaskopfresektion in Kombina tion mit einer Transplantation [43]. Nach Auswahl von Patienten mit niedrigeren Tumorstadien konnte mit diesem Kon zept ein akzeptables Langzeitüberleben erreicht werden, insbesondere wenn die Operation mit einer neoadjuvanten The rapie kombiniert wurde [44,45].…”