The Role of Liver Transplantation in Hepatobiliary Malignancy. A Retrospective Analysis of 95 Patients with Particular Regard to Tumor Stage and Recurrence

Abstract

The role of hepatic transplantation in patients with nonresectable liver or bile duct cancer remains a controversial issue. An analysis of 95 consecutive cases was undertaken to evaluate retrospectively the pathological tumor stage--in accordance with the TNM system--and outcome after transplantation. Included were patients with the following diagnoses: hepatocellular carcinoma (n = 52), cholangiocellular carcinoma (n = 10), hepatoblastoma (n = 2), hemangiosarcoma (n = 2), bile duct carcinoma (n = 20), and liver metastases from different primary tumors (n = 9). The overall actuarial survival rate at 5 years was 20.4%. Median survival improved significantly within the last 4 years as compared to the preceding era (18.06 vs. 4.0 months). Currently 27 patients are alive, with the longest follow-up more than 12 years. The incidences of residual or recurrent tumor were 27 and 28, respectively. Particularly in patients who underwent transplantation for hepatocellular or bile duct carcinoma without extra-hepatic tumor spread, the results were significantly better; median survival time achieved for these two groups were 120 (p less than 0.01) and 35 months (p less than 0.05). Prolonged survival without tumor recurrence was not seen in patients with cholangiocellular carcinoma or liver metastases. These results demonstrate clearly that liver transplantation for hepatobiliary malignancy is still justified on the premises of careful patient selection by adequate tumor staging.

Resection, including transplantation, for hepatoblastoma and hepatocellular carcinoma: Impact on survival

“…Ringe et al, 19 in a retrospective analysis of 95 patients transplanted for malignancy, found a better prognosis in earlier disease stages and in recipients without lymph node involvement. Iwatsuki et al found similar results in HCC patients; vascular invasion, tumor number, tumor shape, and lymph node invasion were found to be significant independent factors affecting survival.…”

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

“…The 5-year survival rate after surgery with curative intent ranges in literature reports from 5% to 20%. [3][4][5][6][7][8][9][10][11][12][13] This has been explained in part by a high perioperative mortality due to hepatic failure and sepsis, particularly when a major hepatic resection is combined with excision of the extrahepatic bile duct. Preoperative intubation of the obstructed biliary tract, antibiotic therapy, and embolization of the portal vein branch may reduce the perioperative mortality.…”

“…4,6,[8][9][10][11][12]26 To achieve this, hepatic resection has been combined with pancreatoduodenectomy, 27 or other extended procedures when the tumor has invaded the liver or peripheral region. 12,28,29 Other more radical options have been liver transplantation plus regional lymphadenectomy 4 and organ cluster transplantation. 19,20 In addition to securing tumor-free margins, liver transplantation or its more drastic variations may offer the only hope when extensive hilar cholangiocarcinoma is associated with advanced cirrhosis of the liver, sclerosing cholangitis, or both.…”

Hepatocellular carcinoma screening in patients waiting for liver transplantation: A decision analytic model

“…22 These tumors are believed to confer a worse prognosis, likely because they reflect metastatic disease. [23][24][25][26][27][28][29] Conversely, certain patients can be upgraded on the transplant list and thus have a shorter wait for transplantation.…”