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Review
. 2025 May 27;17(5):105783.
doi: 10.4240/wjgs.v17.i5.105783.

Liver transplantation for combined hepatocellular cholangiocarcinoma: Current evidence, selection criteria, and therapeutic controversies

Rui-Quan Zhou  1 , Pei-Jun Yang  1 , Tian-Tong Liu  1 , Dong-Dong Han  1 , Xiao-Lei Liu  1 , Li-Guo Liu  1 , Shuang Si  1 , Shi-Wei Yang  1 , Shuai-Shuai Xu  1 , Yi-Wen Guo  1 , Hai-Dong Tan  2
Affiliations
Review

Liver transplantation for combined hepatocellular cholangiocarcinoma: Current evidence, selection criteria, and therapeutic controversies

Rui-Quan Zhou et al. World J Gastrointest Surg. .

Abstract

Combined hepatocellular cholangiocarcinoma (cHCC-CCA) is a rare and aggressive primary liver malignancy characterized by features of both HCC and CCA. Preoperative diagnosis remains challenging because of overlapping imaging and histopathological features, which often lead to misclassification. Although liver resection is the primary curative therapy, the efficacy of liver transplantation (LT) remains controversial. Historically, LT has been considered contraindicated owing to the poor prognosis, high recurrence rate of cHCC-CCA, and the potential for organ wastage. Recent studies have suggested that LT may benefit carefully selected patients, particularly those with early-stage tumors or cirrhosis. However, there is no consensus on the criteria for LT in patients with cHCC-CCA. Lymphadenectomy and vascular resection strategies were discussed along with locoregional and systemic therapies. This review synthesized the current evidence on surgical strategies for cHCC-CCA, focusing on evolving LT criteria and outcomes.

Keywords: Combined hepatocellular cholangiocarcinoma; Liver resection; Liver transplantation; Locoregional therapy; Lymphadenectomy; Milan criteria; Systemic treatment; Vascular resection.

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Conflict of interest statement

Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.

Figures

Figure 1
Figure 1
Treatment algorithm for combined hepatocellular-cholangiocarcinoma. cHCC-CCA: Combined hepatocellular cholangiocarcinoma.
See this image and copyright information in PMC

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