Liver transplantation for cholangiocarcinoma- a hammer to crack a very tough nut?

I am woefully behind in posting new material on my blog for which I apologise. Everyone else’s deadlines seem to have taken over mine. Nevertheless it is a new year and I will resolve to spend more time and effort posting here.

Here is my highlight from the january edition of the journal HPB on quite a controversial area.

This month’s HPB sees the much awaited publication of the Dublin experience of liver transplantation for cholangiocarcinoma. The group followed the previously published Mayo protocol of treating patients with cholangiocarcinoma with brachytherapy, external beam radiotherapy and 5-fluorouracil. Patients who had no radiological evidence of disease progression underwent laparotomy or laparoscopy and negative lymph node biopsy and ifthere was no evidence of peritoneal dissemination were listed for transplantation. 27 patients entered the protocol and 20 progressed to transplantation, 6 of whom required a simultaneous pancreaticoduodenectomy. Hospital mortality was 4/20 or 20% but thereafter survival was reasonable giving overall survival estimates of approximately 75% at 1 year and 60% at 3 years. Liver transplantation for cholangiocarcinoma is a major undertaking but in oncological terms the results are very good. The present series found best outcomes in patients with a complete pathological response to neoadjuvant therapy although it could be argued that such patients may have experienced prolonged survival without transplantation. The authors highlight the difficulty in determining the presence or absence of viable tumour in the liver after chemoradiotherapy. The Dublin series did not replicate the excellent results previously published in similarly selected patients from the Mayo Clinic, however, there is increasing interest in the use of liver transplantation for primary and metastatic disease including cholangiocarcinoma, neuroendocrine and colorectal metastases. The availability of organs for transplantation remains a limiting factor but carefully designed studies such as this, strengthen the case for extending indications for liver transplantation at least within the context of a clinical trial.

Neoadjuvant chemoradiotherapy followed by liver transplantation for unresectable cholangiocarcinoma: a single-centre national experience (pages 91–98)

Sophie Duignan, Donal Maguire, Chamarajanagar S. Ravichand, Justin Geoghegan, Emir Hoti, David Fennelly, John Armstrong, Kathy Rock, Helen Mohan and Oscar Traynor

Article first published online: 18 APR 2013 | DOI: 10.1111/hpb.12082

 

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