The perspective of liver transplantation for cholangiocarcinoma

Jonas, Sven; Neuhaus, P.

doi:10.1002/lt.21248

Cited by 6 publications

(3 citation statements)

References 30 publications

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“…It provides the opportunity for wider excision margins, which potentially expands the number of patients eligible for curative surgical interventions 7. Second, liver transplantation achieved decreased possibility of tumor spillage because there is no need to dissect the porta hepatis in the region of tumor, and thus theoretically permitting R0 resection even in very locally advanced tumors beyond the criteria for resection and reducing the incidence of tumor recurrence after complete hepatectomy 9. Finally, patients with cholangiocarcinoma arising in the setting of PSC will tolerate resection poorly, and therefore, liver transplantation may offer a totally healthy liver and normal liver function to the individuals 38…”

Section: Discussionmentioning

confidence: 99%

“…Total hepatectomy followed by subsequent OLT seems to offer a chance for significant prolongation of survival with wide tumor‐free margins and without underlying liver disease 6. Taken into consideration, OLT was initially proposed as an optimal solution for patients with irresectable cholangiocarcinoma 7–10. Despite sound theoretical argument in favor of liver transplantation, the early experience with OLT alone for bile duct cancer was uniformly disappointing because of frequent tumor relapse 11–13.…”

mentioning

confidence: 99%

“…Favorable results from the University of Nebraska in 2002 also suggested that cholangiocarcinoma should not be considered as an absolute exclusion criterion for OLT following radiochemotherapy 17. However, there is much debate about the role of liver transplantation in the treatment of cholangiocarcinoma 7–18. Therefore, the purpose of our study is to conduct a systematic review and meta‐analysis of the published literature concerning efficacy and safety of OLT in patients with cholangiocarcinoma.…”

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confidence: 99%

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Efficacy and safety of liver transplantation in patients with cholangiocarcinoma: A systematic review and meta‐analysis

Bai

Shi

et al. 2012

Intl Journal of Cancer

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The aim of our study was to evaluate the efficacy and safety of liver transplantation in patients with cholangiocarcinoma. According to the requirements of Cochrane systematic review, a thorough literature search was performed in PubMed/ Medline, Embase and Cochrane electronic databases between 1995 and 2009 in terms of the key words ''liver transplantation'' and ''cholangiocarcinoma,'' ''cholangiocellular carcinoma'' or ''bile duct cancer,'' with restricted articles for the English language. Data were processed for a meta-analysis by Stata 10 software. Altogether 14 clinical trials containing 605 transplanted patients of bile duct cancers were finally enrolled in our study. In addition, the overall pooled incidence of complications was 0.62 (95% CI 5 0.44-0.78), among which that of OLT-PAT group (0.58; 95% CI 5 0.20-0.92) was relatively acceptable compared to those of liver transplantation alone (0.61; 95% CI 5 0.33-0.85) and liver transplantation with extended bile duct resection (0.78; 95% CI 5 0.55-0.94). In comparison to curative resection of cholangiocarcinoma with the 5-year survival rate reported from 20 to 40%, the role of liver transplantation alone is so limited. In the future, attention will be focused on liver transplantation following neoadjuvant radiochemotherapy, which requires a well-designed, prospective randomized controlled study.Bile duct cancer or cholangiocarcinoma, which arises from the epithelium of bile ducts, is the second most common primary malignant tumor of the liver after hepatocellular carcinoma.1 Although hepatic resection represents the primary treatment for cholangiocarcinoma, extensive perineural and lymphatic invasion, bilateral liver involvement and vascular encasement frequently preclude potentially complete resection.2 In addition, extensive surgical resection is not tolerated in patients with primary sclerosing cholangitis (PSC) because of the underlying liver dysfunction.3 Even if curative resection is achieved, cholangiocarcinoma, to date, remains a devastating and challenging disease with 5-year survival rates reported from 20 to 40%. 4 As for palliative modalities including biliary drainage, irradiation or chemotherapy and photodynamic therapy, the median survival for unresectable individuals is less than 12 months. 1Since the late 1990s, orthotopic liver transplantation (OLT) has been established for end-stage liver disease as well as hepatocellular carcinoma.5 Total hepatectomy followed by subsequent OLT seems to offer a chance for significant prolongation of survival with wide tumor-free margins and without underlying liver disease.6 Taken into consideration, OLT was initially proposed as an optimal solution for patients with irresectable cholangiocarcinoma.7-10 Despite sound theoretical argument in favor of liver transplantation, the early experience with OLT alone for bile duct cancer was uniformly disappointing because of frequent tumor relapse. 11-13Reports from Hannover in 1996 described that 1-, 3-and 5-year survival rates for 25 liver transplants of proxima...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Efficacy and safety of liver transplantation in patients with cholangiocarcinoma: A systematic review and meta‐analysis

Bai

Shi

et al. 2012

Intl Journal of Cancer

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Transplantation pathology

Hübscher¹,

Clouston²

2012

MacSween's Pathology of the Liver

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Cholangiocarcinoma

Mosconi

Beretta

Labianca

et al. 2009

Critical Reviews in Oncology/Hematology

157

135

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Cholangiocarcinoma is an uncommon adenocarcinoma with poor prognosis. Although the 1-year survival has increased over time, the 5-year survival has not shown any significant change (less than 5%). Cure can only be expected from surgical resection of early stage tumours but most patients initially present with advanced disease. Cancer cachexia, liver failure, and recurrent sepsis due to biliary obstruction are among the main causes of mortality. Patients' prognosis is strongly related to radical surgery and complete resection is the most effective therapy; the location within the biliary tree (proximal versus distal) has no impact on survival when a complete resection is achieved despite the fact the rate of resectability is up to 70% in case of distal cancer and 15-20% for high bile ducts tumours. Prognosis of cholangiocarcinoma remains poor even with aggressive surgical therapy because of the high incidence of local or regional recurrence and distant metastasis. Based on these data many questions need an answer: is there a role for adjuvant chemotherapy or radiotherapy? Neoadjuvant treatments provide best results? There is a standard therapy in unresectable or metastatic cholangiocarcinoma? This report tries to answer to frequently asked questions that the readers are faced with their patients every day (from diagnostic procedures to palliative treatment) and tries to suggest useful information for their professional practice.

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The perspective of liver transplantation for cholangiocarcinoma

Cited by 6 publications

References 30 publications

Efficacy and safety of liver transplantation in patients with cholangiocarcinoma: A systematic review and meta‐analysis

Efficacy and safety of liver transplantation in patients with cholangiocarcinoma: A systematic review and meta‐analysis

Transplantation pathology

Cholangiocarcinoma

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