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Comparative Study
. 2005 Sep;242(3):451-8; discussion 458-61.
doi: 10.1097/01.sla.0000179678.13285.fa.

Liver transplantation with neoadjuvant chemoradiation is more effective than resection for hilar cholangiocarcinoma

David J Rea  1 , Julie K Heimbach, Charles B Rosen, Michael G Haddock, Steven R Alberts, Walter K Kremers, Gregory J Gores, David M Nagorney
Affiliations
Comparative Study

Liver transplantation with neoadjuvant chemoradiation is more effective than resection for hilar cholangiocarcinoma

David J Rea et al. Ann Surg. 2005 Sep.

Abstract

Objective: Compare survival after neoadjuvant therapy and liver transplantation with survival after resection for patients with hilar CCA.

Summary background data: We developed a protocol combining neoadjuvant radiotherapy, chemosensitization, and orthotopic liver transplantation for patients with operatively confirmed stage I and II hilar CCA in 1993. Since then, patients with unresectable CCA or CCA arising in the setting of PSC have been enrolled in the transplant protocol. Patients with tumors amenable to resection have undergone excision of the extrahepatic duct with lymphadenectomy and liver resection.

Methods: We reviewed our experience between January 1993 and August 2004 and compared patient survival between the treatment groups.

Results: Seventy-one patients entered the transplant treatment protocol and 38 underwent liver transplantation. Fifty-four patients were explored for resection. Twenty-six (48%) underwent resection, and 28 (52%) had unresectable disease. One-, 3-, and 5-year patient survival were 92%, 82%, and 82% after transplantation and 82%, 48%, and 21% after resection (P = 0.022). There were fewer recurrences in the transplant patients (13% versus 27%).

Conclusions: Liver transplantation with neoadjuvant chemoradiation achieved better survival with less recurrence than conventional resection and should be considered as an alternative to resection for patients with localized, node-negative hilar CCA.

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Figures

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FIGURE 1. Patient survival from start of neoadjuvant therapy (all 71 patients in transplant protocol) or resection.
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FIGURE 2. Patient survival from operation.
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FIGURE 3. Survival after operation for patients without PSC.
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FIGURE 4. Patient survival after resection.
See this image and copyright information in PMC

References

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