Tumors With Intrahepatic Bile Duct Differentiation in Cirrhosis

Abstract

This series showed that patients with CCA within Milan criteria may be able to achieve acceptable long-term post-LT survival.

Liver transplantation for “very early” intrahepatic cholangiocarcinoma: International retrospective study supporting a prospective assessment

“…We were able to identify 48 patients who had only iCCA at explant, representing by far the largest cohort of patients with this characteristic published to date. (6,8,(12)(13)(14)(15)(16) Also, we were able to almost duplicate the number of patients in the very early iCCA group from the previous Spanish multicenter experience, (8) adding value to the current work.…”

“…Most of these patients had lesions that were misdiagnosed—in the preoperative setting—as being HCC; but some patients were transplanted for decompensated cirrhosis, and the tumors were incidentally found. We were able to identify 48 patients who had only iCCA at explant, representing by far the largest cohort of patients with this characteristic published to date . Also, we were able to almost duplicate the number of patients in the very early iCCA group from the previous Spanish multicenter experience, adding value to the current work.…”

Analysis of Liver Resection Versus Liver Transplantation on Outcome of Small Intrahepatic Cholangiocarcinoma and Combined Hepatocellular‐Cholangiocarcinoma in the Setting of Cirrhosis

“…When compared with the LR group, patients who underwent LT were younger (59 versus 63 [48-80] years; P = 0.03) and had a lower BMI (27 versus 29 [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] kg/m 2 ; P = 0.046; Table 1). A significantly higher rate of diabetes was seen in transplanted patients (23 [47%] versus 6 [23%]; P = 0.04), and they had a significantly higher MELD score (12 versus 7 [6][7][8][9][10][11][12][13][14]; P < 0.001). The median time elapsing between tumor diagnosis and liver surgery was significantly different for LT patients (394 versus 131 [5-864] days; P = 0.005).…”

“…(8,9) However, recent reports have demonstrated that LT is appropriate in a well-selected group of patients with cirrhosis, with 5-year survival rates ranging from 57% to 73%. (10,11) It appears that patients with very early iCCA, defined by a tumor size ≤2 cm, can be safely transplanted and achieve a 5-year actuarial survival rate of 65%. (12) Indeed, the radiological detection and characterization of small tumors before surgery are extremely challenging, particularly in a cirrhotic liver, as the classic enhancement patterns of iCCA become less reliable with lesions ≤2 cm.…”

“…(13) The issue of tumors with a diameter >2 but ≤5 cm is clinically relevant because it appears that post-LT outcomes in patients with a tumor within the Milan criteria are also good. (10) This raises the question that the tumor size cutoff point could perhaps be increased to 5 cm.…”