Treatment of Hilar Cholangiocarcinoma (Klatskin Tumors) with Hepatic Resection or Transplantation

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

doi:10.1016/s1072-7515(98)00207-5

Cited by 244 publications

(152 citation statements)

References 21 publications

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“…10,[46][47][48][49] Studies assessing the impact of positive surgical margins on outcomes after LT for CCC indirectly support our observations in that outcomes are uniformly poor for patients with CCC undergoing LT with positive resection margins. 22,23 Obtaining disease-free surgical margins appears to be of paramount importance when evaluating potential candidates for LT. However, the use of extended resections in immunosuppressed patients can be associated with significant complication rates, as seen in this series.…”

Section: Discussionmentioning

confidence: 99%

“…Other groups have applied more radical resections and cluster transplantation to patients with extensive CCC undergoing LT. 23,50,51 Outcomes are not good; therefore, patients with CCC extending into other organs probably should not be offered LT.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

mentioning

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: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

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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“…Survival rates of 74% at 1 year, 34% at 3 years, and 9% at 5 years were reported in another series of 34 patients treated by resection. 9 The patients with the most favorable outcome were pathological tumor, node, and metastases stage 0 to 1, with tumor-free surgical margins and disease-free lymph nodes. A recent Japanese series described a remarkable resectability rate of 79% by incorporating partial hepatectomy into 86% of the resection procedures, yielding a 5-year survival rate of 26%.…”

Section: Treatmentmentioning

confidence: 99%

“…A recent Japanese series described a remarkable resectability rate of 79% by incorporating partial hepatectomy into 86% of the resection procedures, yielding a 5-year survival rate of 26%. 9 These investigators suggested that it was particularly important to include resection of the caudate lobe because this is commonly a site of early tumor dissemination.…”

Section: Treatmentmentioning

confidence: 99%

Treatment options for other hepatic malignancies

O’Grady¹

2000

Liver Transpl

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Key Points 1. Resection rates for cholangiocarcinoma (unrelated to primary sclerosing cholangitis) have increased to 54% to 79%, and the subsequent 5-year survival rates are 24% to 31%. 2. Multimodality approaches involving various combinations of chemotherapy, irradiation, and surgery increasingly are being used to treat cholangiocarcinoma. 3. The role of liver transplantation in the management of cholangiocarcinoma is limited by the perception that it is inappropriate to use scarce organs when 5-year survival rates are 25%. 4. Liver transplantation is an important intervention in patients with tumors that remain unresectable after chemotherapy. The role of liver transplantation in patients with extrahepatic disease that responds to chemotherapy is controversial. Careful timing of surgery is required to avoid secondary drug resistance. 5. Liver transplantation has been successfully applied to a range of rare hepatic malignancies, but small numbers preclude strong recommendations on the appropriateness of this practice. (Liver Transpl 2000;6:S23-S29.)

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Liver Transplant as a Treatment of Primary and Secondary Liver Neoplasms

Gorji,

Brown,

Limkemann

et al. 2024

JAMA Surg

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ImportanceLiver malignancies are an increasing global health concern with a high mortality. We review outcomes following liver transplant for primary and secondary hepatic malignancies.ObservationsTransplant may be a suitable treatment option for primary and secondary hepatic malignancies in well-selected patient populations.Conclusions and RelevanceMany patients with primary or secondary liver tumors are not eligible for liver resection because of advanced underlying liver disease or high tumor burden, precluding complete tumor clearance. Although liver transplant has been a long-standing treatment modality for patients with hepatocellular carcinoma, recently transplant has been considered for patients with other malignant diagnoses. In particular, while well-established for hepatocellular carcinoma and select patients with perihilar cholangiocarcinoma, transplant has been increasingly used to treat patients with intrahepatic cholangiocarcinoma, as well as metastatic disease from colorectal liver and neuroendocrine primary tumors. Because of the limited availability of grafts and the number of patients on the waiting list, optimal selection criteria must be further defined. The ethics of organ allocation to individuals who may benefit from prolonged survival after transplant yet have a high incidence of recurrence, as well as the role of living donation, need to be further discerned in the setting of transplant oncology.

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Treatment of Hilar Cholangiocarcinoma (Klatskin Tumors) with Hepatic Resection or Transplantation

Abstract: Background-Because of the rarity of hilar cholangiocarcinoma, its prognostic risk factors have not been sufficiently analyzed. This retrospective study was undertaken to evaluate various pathologic risk factors which influenced survival after curative hepatic resection or transplantation.

Cited by 244 publications

References 21 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

Treatment options for other hepatic malignancies

Liver Transplant as a Treatment of Primary and Secondary Liver Neoplasms

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