Casavilla FA, Marsh JW, Iwatsuki S, et al. (1997) Hepatic resection and transplantation for peripheral cholangiocarcinoma. J Am Coll Surg, 185(5):429-436
Abstract: Recent publications have questioned the role of orthotopic liver transplantation (OLT) in treating advanced or unresectable peripheral cholangiocarcinoma (Ch-Ca). We reviewed our experience with Ch-Ca to determine survival rates, recurrence patterns, and risk factors. Table 3
Mortality within 30 days was 7.4%. Overall patient and tumor-free survival rates were 64% and 57% at 1 year, 34% and 34% at 3 years, and 26% and 27% at 5 years after operation. Both hepatic resection and OLT are effective therapies for Ch-Ca when the tumor can be removed with adequate margins, the lesion is singular, and lymph nodes are not involved.
Discussion
The bile duct located on the hepatic side of the first intrahepatic branch of the right and left hepatic duct is considered “intrahepatic” or “peripheral.” The remaining part of the bile duct is considered “extrahepatic,” including the hilum of the liver.
The longterm tumor free and patient survival rates were similar for the two groups. Although patient survival at 5 years was greater in the Hx group, the 5-year tumor-free survival was greater in the OLT group (31% versus 25%), despite the more advanced disease.
The median survival after Hx or OLT for tumor stages I and II combined, III, and IV was 77, 18, and 17.5 months, respectively. The actuarial 1-, 3-, and 5-year patient survival rates were 90%, 70%, and 70% for stages I and II; 60%, 33.3%, and 25% for stage III; and 55.6%, 21.6%, and 13% for stage IV.
Our multivariate analysis revealed that, in addition to metastatic disease, positive surgical margins, multiple gross tumors, and lymph node involvement were independent risk factors for poor survival after both Hx and OLT in patients with Ch-Ca. Conversely, the actuarial 1-, 3-, and 5-year survival rates of patients with none of these three negative predictors were significantly higher than those of patients with at least one of these risk factors (74.2%, 66.5%, and 66.5% versus 58%, 18%, and 9%, respectively). Because we did not find any difference in time to recurrence between the Hx and OLT groups, our results do not support the hypothetical (and logical) contention that immunosuppression shortens the tumor-free interval rate. The indications for OLT can reasonably include at least some appropriately staged patients with Ch-Ca.
Abstract: Recent publications have questioned the role of orthotopic liver transplantation (OLT) in treating advanced or unresectable peripheral cholangiocarcinoma (Ch-Ca). We reviewed our experience with Ch-Ca to determine survival rates, recurrence patterns, and risk factors. Table 3
Mortality within 30 days was 7.4%. Overall patient and tumor-free survival rates were 64% and 57% at 1 year, 34% and 34% at 3 years, and 26% and 27% at 5 years after operation. Both hepatic resection and OLT are effective therapies for Ch-Ca when the tumor can be removed with adequate margins, the lesion is singular, and lymph nodes are not involved.
Discussion
The bile duct located on the hepatic side of the first intrahepatic branch of the right and left hepatic duct is considered “intrahepatic” or “peripheral.” The remaining part of the bile duct is considered “extrahepatic,” including the hilum of the liver.
The longterm tumor free and patient survival rates were similar for the two groups. Although patient survival at 5 years was greater in the Hx group, the 5-year tumor-free survival was greater in the OLT group (31% versus 25%), despite the more advanced disease.
The median survival after Hx or OLT for tumor stages I and II combined, III, and IV was 77, 18, and 17.5 months, respectively. The actuarial 1-, 3-, and 5-year patient survival rates were 90%, 70%, and 70% for stages I and II; 60%, 33.3%, and 25% for stage III; and 55.6%, 21.6%, and 13% for stage IV.
Our multivariate analysis revealed that, in addition to metastatic disease, positive surgical margins, multiple gross tumors, and lymph node involvement were independent risk factors for poor survival after both Hx and OLT in patients with Ch-Ca. Conversely, the actuarial 1-, 3-, and 5-year survival rates of patients with none of these three negative predictors were significantly higher than those of patients with at least one of these risk factors (74.2%, 66.5%, and 66.5% versus 58%, 18%, and 9%, respectively). Because we did not find any difference in time to recurrence between the Hx and OLT groups, our results do not support the hypothetical (and logical) contention that immunosuppression shortens the tumor-free interval rate. The indications for OLT can reasonably include at least some appropriately staged patients with Ch-Ca.
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