Liver transplantation for cholangiocarcinoma: Current status and new insights

Sevilla, Elena Fernández de; Echeverri, Juan; Charco, Ramón

doi:10.4254/wjh.v7.i22.2396

Cited by 52 publications

(53 citation statements)

References 81 publications

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“…Considering these poor outcomes and the scarcity of organs, iCCA has been a contraindication for liver transplantation. A recent series found that cirrhotic patients with uninodular iCCA of less than 2 cm had a similar OS after liver transplantation as matched HCC patients . More recently, highly selected patients with well‐differentiated iCCA of less than 2 cm (ie, very early iCCA) had a 5‐year OS of 65% .…”

Section: Intrahepatic Cholangiocarcinomamentioning

confidence: 99%

Surgery for cholangiocarcinoma

Cillo

Fondevila

Donadon

et al. 2019

Liver International

239

224

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Surgical resection is the only potentially curative treatment for patients with cholangiocarcinoma. For both perihilar cholangiocarcinoma (pCCA) and intrahepatic cholangiocarcinoma (iCCA), 5‐year overall survival of about 30% has been reported in large series. This review addresses several challenges in surgical management of cholangiocarcinoma. The first challenge is diagnosis: a biopsy is typically avoided because of the risk of seeding metastases and the low yield of a brush of the bile duct. However, about 15% of patients with suspected pCCA are found to have a benign diagnosis after resection. The second challenge is staging; even with the best preoperative imaging, a substantial percentage of patients has occult metastatic disease detected at staging laparoscopy or early recurrence after resection. The third challenge is an adequate volume and function of the future liver remnant, which may require preoperative biliary drainage and portal vein embolization. The fourth challenge is a complete resection: a positive bile duct margin is not uncommon because the microscopic biliary extent of disease may be more extensive than perceived on imaging. The fifth challenge is the high post‐operative mortality that has decreased in very high volume Asian centres, but remains about 10% in many Western referral centres. The sixth challenge is that even after a complete resection most patients develop recurrent disease. Recent randomized controlled trials found conflicting results regarding the benefit of adjuvant chemotherapy. The final challenge is to determine which patients with cholangiocarcinoma should undergo liver transplantation rather than resection.

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Section: Intrahepatic Cholangiocarcinomamentioning

confidence: 99%

Surgery for cholangiocarcinoma

Cillo

Fondevila

Donadon

et al. 2019

Liver International

239

224

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“…Sampling error may also contribute to misdiagnosis, especially in the setting of mixed tumors, where the HCC component may be more prominent and the CCA component is missed. Third, patients regardless of whether they are early or advanced CCA based on preoperative imaging have an estimated recurrence of at least 30% . Even in the international multicenter cohort that suggested early CCA as candidates for LT, they reported a recurrence rate of 13%‐20% in the early group .…”

Section: Discussionmentioning

confidence: 98%

“…Even with distinct radiologic patterns, ICC continues to be misdiagnosed and unintentionally transplanted among roughly 1%‐3% of all LT …”

mentioning

confidence: 99%

Liver transplantation for intrahepatic cholangiocarcinoma

et al. 2018

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Although hepatocellular carcinoma (HCC) has become a common indication for liver transplantation (LT), intrahepatic cholangiocarcinoma (ICC) and combined hepatocellular carcinoma-cholangiocarcinoma (cHCC-CCA) are historically contraindicated due to their aggressive behavior. On the basis of recent experiences, some groups have proposed a clinical trial investigating the role of LT for patients with early cholangiocarcinoma (CCA), defined as a single lesion ≤ 2 cm. The purpose of this study is to assess the clinicopathologic features and outcomes following LT for patients who were initially diagnosed with HCC and subsequently found to have either ICC or cHCC-CCA on explant. Patients with the diagnosis of primary liver cancer (PLC) after LT from a single center were retrospectively reviewed. Outcomes for patients with early CCA were compared with patients with HCC within Milan criteria (MC). Out of 618 patients transplanted with PLC, 44 patients were found to have CCA on explant. On the basis of preoperative imaging, 12 patients met criteria for early CCA and were compared with 319 patients who had HCC within MC. The 1- and 5-year overall survival for early CCA versus HCC was 63.6% versus 90.0% and 63.6% versus 70.3% (log-rank, P = 0.25), respectively. Overall recurrence was 33.3% for early CCA versus 11% for HCC. On explant the patients with CCA were more likely understaged with higher tumor grade and vascular invasion. In conclusion, patients with CCA present a diagnostic challenge, which often leads to the finding of more aggressive lesions on explant after LT, higher recurrence rates, and worse post-LT survival. Careful consideration of this diagnostic conundrum needs to be made before a clinical trial is undertaken. Liver Transplantation 24 634-644 2018 AASLD.

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“…Prospective, randomized clinical trials are needed to confirm the benefits of OLT in ICCA. At least for now, we know that patients with vascular and/ or lymphatic invasion and/or tumor size larger than 2 cm are likely to have a higher recurrence rate and may not benefit from OLT (22).…”

Section: Liver Transplantationmentioning

confidence: 99%

Therapeutic options for intrahepatic cholangiocarcinoma

Bupathi

Ahn

Bekaii‐Saab

2017

Hepatobiliary Surg. Nutr.

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Biliary tract cancer (BTC) is a heterogeneous group of cancers, which is composed of intrahepatic cholangiocarcinoma (ICCA), extrahepatic cholangiocarcinoma (ECCA), gallbladder cancers and ampullary carcinomas. While all anatomic subgroups are treated uniformly, our understanding about the pathogenesis has allowed us to reason that each group represents a clinically and genetically diverse disease.The majority of patients present with locally advanced or metastatic disease, where the standard treatment is combination systemic cytotoxic chemotherapy with gemcitabine and cisplatin. While most receive a clinical benefit from chemotherapy, patients eventually progress where no standardized therapies are available in the refractory setting. With the use of next generation sequencing, we have come to understand that ICCA is a diverse genomic disease with many actionable alterations that may serve as potential therapeutic targets. Further studies investigating the role of novel targeted agents (as a single agent or with combination chemotherapy) will hopefully provide additional treatment options for this highly lethal disease.

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Liver transplantation for cholangiocarcinoma: Current status and new insights

Cited by 52 publications

References 81 publications

Surgery for cholangiocarcinoma

Surgery for cholangiocarcinoma

Liver transplantation for intrahepatic cholangiocarcinoma

Therapeutic options for intrahepatic cholangiocarcinoma

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