Liver Transplantation for Unresectable Perihilar Cholangiocarcinoma

Julie K. Heimbach; Gregory J. Gores; Michael G. Haddock; Steven R. Alberts; Scott L. Nyberg; Michael B. Ishitani; Charles B. Rosen

doi:10.1055/s-2004-828896

Seminars in Liver Disease, Table of Contents

Semin Liver Dis 2004; 24(2): 201-207
DOI: 10.1055/s-2004-828896

Liver Transplantation for Unresectable Perihilar Cholangiocarcinoma

Julie K. Heimbach¹ , Gregory J. Gores¹ , Michael G. Haddock² , Steven R. Alberts³ , Scott L. Nyberg¹ , Michael B. Ishitani¹ , Charles B. Rosen¹ ^, ⁴

¹William J von Liebig Transplant Center, Mayo Clinic College of Medicine, Rochester, Minnesota
²Department of Radiation Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota
³Department of Medical Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota
⁴Associate Professor of Surgery, William J von Liebig Transplant Center, Mayo Clinic College of Medicine, Rochester, Minnesota

Abstract

Patients with unresectable, stage I and II perihilar cholangiocarcinoma were treated with neoadjuvant external beam irradiation, brachytherapy, and 5-fluorouracil and/or oral capecitabine prior to liver transplantation. Fifty-six patients underwent treatment between 1993 and 2003. Four patients died and 4 had disease progression prior to completion of neoadjuvant therapy. Forty-eight patients underwent operative staging and 14 had findings precluding transplantation. Twenty-eight patients underwent transplantation and 6 patients are awaiting transplantation. Three patients died from perioperative complications, and 4 developed recurrent disease 22 to 63 months after transplantation. Actuarial patient survival was 54% at 5 years for all 56 patients, 64% for 48 operatively staged patients, and 84% for 34 patients with negative staging operations. Actuarial survival was 88% at 1 year and 82 % 5 years after transplantation. Neoadjuvant chemoradiotherapy with liver transplantation achieves excellent results for patients with localized, regional lymph node negative, hilar cholangiocarcinoma.

KEYWORDS

Cholangiocarcinoma - liver transplantation - neoadjuvant therapy

Full Text

References

REFERENCES

1 Carriaga M T, Henson D E. Liver, gallbladder, extrahepatic bile ducts, and pancreas. Cancer. 1995; 75 171-190
2 Jemal A, Murray T, Samuels A et al.. Cancer statistics, 2003. CA Cancer J Clin. 2003; 53 5-26
3 Rosen C B, Nagorney D M. Cholangiocarcinoma complicating primary sclerosing cholangitis. Semin Liver Dis. 1991; 11 26-30
4 Kaya M, de Groen P C, Angulo P et al.. Treatment of cholangiocarcinoma complicating primary sclerosing cholangitis: the Mayo Clinic experience. Am J Gastroenterol. 2001; 96 1164-1169
5 Bergquist A, Ekbom A, Olsson R et al.. Hepatic and extrahepatic malignancies in primary sclerosing cholangitis. J Hepatol. 2002; 36 321-327
6 Ponsioen C Y, Vrouenraets S M, Prawirodirdjo W et al.. Natural history of primary sclerosing cholangitis and prognostic value of cholangiography in a Dutch population. Gut. 2002; 51 562-566
7 Ammori B J, Jenkins B L, Lim P C et al.. Surgical strategy for cystic diseases of the liver in a western hepatobiliary center. World J Surg. 2002; 26 462-469
8 Nakeeb A, Pitt H A, Sohn T A et al.. Cholangiocarcinoma. A spectrum of intrahepatic, perihilar, and distal tumors. Ann Surg. 1996; 224 463-475
9 Jarnagin W R, Fong Y, DeMatteo R P et al.. Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg. 2001; 234 507-519
10 Kosuge T, Yamamoto J, Shimada K et al.. Improved surgical results for hilar cholangiocarcinoma with procedures including major hepatic resection. Ann Surg. 1999; 230 663-671
11 Pichlmayr R, Weimann A, Klempnauer J et al.. Surgical treatment in proximal bile duct cancer. A single-center experience. Ann Surg. 1996; 224 628-638
12 Goldstein R M, Stone M, Tillery G W et al.. Is liver transplantation indicated for cholangiocarcinoma?. Am J Surg. 1993; 166 768-772
13 Iwatsuki S, Todo S, Marsh J W et al.. Treatment of hilar cholangiocarcinoma (Klatskin tumors) with hepatic resection or transplantation. J Am Coll Surg. 1998; 187 358-364
14 Jeyarajah D R, Klintmalm G B. Is liver transplantation indicated for cholangiocarcinoma?. J Hepatobiliary Pancreat Surg. 1998; 5 48-51
15 Loinaz C, Abradelo M, Gomez R et al.. Liver transplantation and incidental primary liver tumors. Transplant Proc. 1998; 30 3301-3302
16 Shunzaburo I, Todo S, Marsh J W et al.. Treatment of hilar cholangiocarcinoma (Klatskin tumors) with hepatic resection or transplantation. J Am Coll Surg. 1998; 187 358-364
17 Meyer C G, Penn I, James L. Liver transplantation for cholangiocarcinoma: results in 207 patients. Transplantation. 2000; 69 1633-1637
18 Jonas S, Kling N, Guckelberger O et al.. Orthotopic liver transplantation after extended bile duct resection as treatment of hilar cholangiocarcinoma. First long-term results. Transpl Int. 1998; 11(Suppl 1) S206-S208
19 Shimoda M, Farmer D G, Colquhoun S D et al.. Liver transplantation for cholangiocellular carcinoma: analysis of a single-center experience and review of the literature. Liver Transpl. 2001; 7 1023-1033
20 Foo M L, Gunderson L L, Bender C E et al.. External radiation therapy and transcatheter iridium in the treatment of extrahepatic bile duct carcinoma. Int J Radiat Oncol Biol Phys. 1997; 39 929-935
21 De Vreede I, Steers J L, Burch P A et al.. Prolonged disease-free survival after orthotopic liver transplantation plus adjuvant chemoirradiation for cholangiocarcinoma. Liver Transpl. 2000; 6 309-316
22 Hasson Z, Gores G J, Rosen C B et al.. Preliminary experience with liver transplantation in selected patients with unresectable hilar cholangiocarcinoma. Surg Oncol Clin N Am. 2002; 11 909-921
23 Sudan D, DeRoover A, Chinnakotla S et al.. Radiochemotherapy and transplantation allow long-term survival for nonresectable hilar cholangiocarcinoma. Am J Transplant. 2002; 2 774-779

Charles B RosenM.D.

Mayo Clinic College of Medicine

200 First Street SW

Rochester, MN 55905

Email: rosen.charles@mayo.edu