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Publications

Journal Article Comparative Study Multicenter Study Ppublish 3 citations

PubMed: 42324714 DOI: 10.1111/liv.70729

Outcomes of Liver Transplant Versus Partial Hepatectomy for Perihilar Cholangiocarcinoma Patients Requiring Arterial Reconstruction.

Liver Int 46(7):e70729

Authors: Edoardo Poletto, Pim B Olthof, Andrea Ruzzenente, Jean-Philippe Adam, Ian P J Alwayn, Emmanuel Boleslawski, Marieke T de Boer, Alexandre Chebaro, Laurence Chiche, Cristina Dopazo, Jeroen Dubbeld, Joris I Erdmann, Abdul Hakeem, Minneke J Coenraad, Hendrien Kuipers, Jean-Yves Mabrut, Charlotte Maulat, Shishir K Maithel, Vincent E de Meijer, Kayvan Mohkam, Sarwa Darwish Murad, Fabrice Muscari, Jens Rolinger, Wojciech G Polak, Michel Rayar, Francesca Ratti, Fabien Robin, Andreas A Schnitzbauer, Ernesto Sparrelid, Frederike G I Van Vilsteren, Robert J Porte, Frederik J H Hoogwater, Bas Groot Koerkamp

Affiliations

  • Department of Surgery, Dentistry, Gynaecology and Paediatrics, Division of General and Hepato-Biliary Surgery, University of Verona, Verona, Italy.
  • Department of Surgery, Division of Hepato-Pancreato-Biliary and Transplant Surgery Erasmus MC Transplant Institute, University Medical Center Rotterdam, Groningen, the Netherlands.
  • Department of Surgery, Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
  • Department of Hepatobiliary and Pancreatic Surgery and Transplantation, University Hopital Bordeaux, Bordeaux, France.
  • Department of Surgery, Division of Transplantation Surgery, LUMC Transplant Center, Leiden University Medical Center, Leiden, the Netherlands.
  • Department of Digestive Surgery and Transplantation, CHU Lille, University of Lille, Lille, France.
  • Department of HBP Surgery and Transplants, Vall D'hebron Hospital Universitari, Vall D'hebron Institut de Recerca (VHIR), Vall D'hebron Barcelona Hospital Campus, Universitat Autónoma de Barcelona, Barcelona, Spain.
  • Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
  • Division of Surgery, Department of Hepatobiliary and Liver Transplant Surgery, St James's University Hospital, Leeds, UK.
  • Department of Gastroenterology and Hepatology, LUMC Transplant Center, Leiden University Medical Center, Leiden, the Netherlands.
  • Department of Digestive Surgery and Liver Transplantation, Hôpital De La Croix Rousse, Lyon, France.
  • Department of Digestive Surgery and Liver Transplantation, Toulouse-Rangueil University Hospital, Toulouse, France.
  • Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA.
  • Department of Gastroenterology and Hepatology, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands.
  • Department of General, Visceral and Transplant Surgery, University HospitalTübingen, Tübingen, Germany.
  • Department of Hepatology, Rennes University Hospital, Rennes, France.
  • Institut national de la Santé et de la Recherche Médicale (Inserm), Rennes, France.
  • Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy.
  • Service de Chirurgie Hépatobiliaire et Digestif, Centre Hospitalier Universitaire de Rennes, Rennes, France.
  • Universitätsklinikum Frankfurt, Klinik für Allgemein-, Viszeral- Und Transplantationschirurgie, Frankfurt am Main, Germany.
  • Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
  • Department of Gastroenterology, Division of Hepatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.

Abstract

BACKGROUND AND AIMS

Liver resection (LR) and orthotopic liver transplantation (OLT) are therapeutic options for locally advanced perihilar cholangiocarcinoma (pCCA) requiring hepatic artery reconstruction (HAR). This study aimed to compare short- and long-term outcomes of LR and OLT. Outcomes were major vascular complications, 90-day mortality, overall survival (OS) and recurrence-free survival (RFS).

METHODS

A cohort of patients undergoing LR with HAR from 10 Western centres was compared with an OLT cohort comprising patients who received or did not receive neoadjuvant chemoradiotherapy (NACR).

RESULTS

109 patients, 60 LR and 49 OLT (22 OLT no-NACR and 27 OLT NACR) were included. LR patients were older and had fewer Bismuth type 4 tumours (38.3% vs. 69.4%, p = 0.009). Positive margins (49.2% vs. 6.5%, p < 0.001) and lymph nodes (54.2% vs. 32.4%, p = 0.058) were found more frequently in LR patients. No differences were found between LR and OLT in major (40% vs. 46.9%, p = 0.56) and vascular complications (23.3% vs. 28.6%, p = 0.66); NACR was an independent prognostic factor for vascular complications (OR 2.63, 95% CI 1.03-6.70, p = 0.043). 90-day mortality (15% for LR vs. 10.2% for OLT, p = 0.57) and 5-year OS (HR 0.68, 95% CI 0.40-1.17, p = 0.17) were similar. Median OS after LR versus OLT was higher but not significant (24 vs. 40 months, p = 0.13). OLT had better 5-year RFS (HR 0.52, 95% CI 0.29-0.96, p = 0.035) than LR. R1 resection (HR 2.07, 95% CI 1.03-4.18, p = 0.041) and perineural invasion (HR 3.64, 95% CI 1.09-12.16, p = 0.035) were independent prognostic factors for RFS.

CONCLUSIONS

LR and OLT for locally advanced pCCA had similar rates of major complications and post-operative mortality, but NACR was associated with increased vascular complications. Survival was difficult to compare in the groups due to their heterogeneity, but OLT, especially with NACR, seems to give better results than LR.

MeSH

Liver Transplantation, Mortality, Liver, Hepatectomy, Transplants, Cholangiocarcinoma, Extrahepatic Cholangiocarcinoma