This multicenter study compares the outcomes of patients with cirrhosis undergoing liver transplantation (LT) or liver resection (LR) between January 2002 and July 2015 who had intrahepatic cholangiocarcinoma (iCCA) or combined hepatocellularcholangiocarcinoma (cHCC-CCA) found incidentally in the native liver. A total of 49 (65%) LT and 26 (35%) LR patients with cirrhosis and histologically confirmed iCCA/cHCC-CCA ≤5 cm were retrospectively analyzed. LT patients had significantly lower tumor recurrence (18% versus 46%; P = 0.01), for which the median diameter of the largest nodule (hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.02-1.12]; P = 0.006) and tumor differentiation (HR, 3.74; 95% CI 1.71-8.17; P = 0.001) were independently predictive. The LT group had significantly higher 5-year recurrence-free survival (RFS; 75% versus 36%; P = 0.004). In patients with tumors >2 cm but ≤5 cm, LT patients had a lower recurrence rate (21% versus 48%; P = 0.06) and a higher 5-year RFS (74% versus 40%; P = 0.06). Independent risk factors for recurrence were LT (protective; HR, 0.23; 95% CI, 0.07-0.82; P = 0.02), the median diameter of the largest nodule (HR, 1.10; 95% CI, 1.02-1.73; P = 0.007), and tumor differentiation (HR, 4.16; 95% CI, 1.37-12.66; P = 0.01). In the LT group, 5-year survival reached 69% and 65% (P = 0.40) in patients with tumors ≤2 cm and >2-5 cm, respectively, and survival was also comparable between iCCA and cHCC-CCA patients (P = 0.29). LT may offer a benefit for highly selected patients with cirrhosis and unresectable iCCA/cHCC-CCA having tumors ≤5 cm. Efforts should be made to evaluate tumor differentiation, and these results need to be confirmed prospectively in a larger population. Liver Transplantation 26 785-798 2020 AASLD. SEE EDITORIAL ON PAGE 748Intrahepatic cholangiocarcinoma (iCCA) accounts for 20%-25% of all cholangiocarcinoma (CCA) cases, and its incidence is rising at an average of 14% per year in Western countries. (1,2) Moreover, the mixed form of iCCA and hepatocellular carcinoma (HCC), referred to as combined hepatocellularcholangiocarcinoma (cHCC-CCA), is well recognized and increasingly reported. (3) Liver cirrhosis is a major risk factor for iCCA, with an odds ratio of 22.92 (95% confidence interval [CI], 18.24-28.79), De Martin et al. De Martin et al. liver transplantatiOn, June 2020

No abstract

Treatment of intrahepatic cholangiocarcinoma remains a major challenge. For an unresectable lesion without extrahepatic spread, liver transplantation could be a potential solution but it is still associated with poor oncologic results owing to the absence of effective neoadjuvant treatment. We report the case of a young man with locally advanced intrahepatic cholangiocarcinoma presenting with multiple intrahepatic metastases and vascular structure involvement. The lesion was significantly downstaged by a multimodal therapy including intra-arterial Yttrium-90 radioembolization, systemic chemotherapy and external radiotherapy, allowing liver transplantation. Three years after the procedure, oncologic outcome is excellent with no sign of recurrence.Multimodal therapy including Yttrium-90 radioembolization could be relevant as neoadjuvant treatment before liver transplantation for unresectable intrahepatic cholangiocarcinoma. Abbrevations: CA 19-9: carbohydrate antigen 19-9; FDG-PET: fluorodeoxyglucose positron emission tomography; HCC: hepatocellular carcinoma; ICC: intrahepatic cholangiocarcinoma; LT: liver transplantation; MRI: magnetic resonance imaging; PHC: perihilar cholangiocarcinoma; Ytt-90: Yttrium-90.

The incidence of intrahepatic and perihilar cholangiocarcinoma is increasing. Surgical resection is the only treatment that can provide long-term survival. The aim of this review was to define the limits to the application of surgery.Résumé : Les cholangiocarcinomes intrahépatiques (CIH) et périhilaires (CPH) sont d'incidence croissante. La résection lorsqu'elle est complète reste le seul traitement compatible avec une survie prolongée. La question à laquelle répond cette revue est de savoir les limites à l'application de ce traitement.