Liver transplantation for perihilar cholangiocarcinoma

Gregory J. Gores, Sarwa Darwish Murad, Julie K. Heimbach, Charles B. Rosen

Research output: Contribution to journalArticle

51 Scopus citations

Abstract

Perihilar cholangiocarcinoma is a complex and devastating disease. Its complexity in part arises from the difficulty of establishing a diagnosis, especially in primary sclerosing cholangitis (PSC) patients. We have found fluorescent in situ hybridization (FISH) of cytologic specimens to be helpful in establishing a diagnosis of cholangiocarcinoma. In particular, FISH polysomy is useful in establishing a diagnosis of this malignancy. Endoscopic ultrasound with fine needle aspirates of regional lymph nodes has high utility in identifying patients who have advanced disease with lymph node metastases. Patients who are resectable by conventional surgical techniques are referred for surgery. However, patients who are not resectable or who have PSC and meet highly selective criteria become eligible for liver transplantation. The protocol employs external beam radiation therapy followed by brachytherapy, and then capecitabine until a staging laparotomy is performed. There is a high dropout rate while patients await liver transplantation of approximately 30% at 12 months, due to tumor progression. Overall, survival rates are approximately 65-70% at 5 years. The disease recurrence rate is 20%. Patients who have masses greater than 3 cm or who do not meet the criteria identified above have worse outcomes. These survival rates are better than those following surgical resection. Vascular complications occur frequently after liver transplantation. Portal venous anastomotic strictures are very common and can be managed by stent placement. In summary, neoadjuvant chemoradiation plus liver transplantation achieves excellent survival for patients with early-stage perihilar cholangiocarcinoma.

Original languageEnglish (US)
Pages (from-to)126-129
Number of pages4
JournalDigestive Diseases
Volume31
Issue number1
DOIs
StatePublished - Jan 1 2013

    Fingerprint

Keywords

  • Cholangiocarcinoma
  • Endoscopic ultrasound
  • Fluorescence in situ hybridization

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Gores, G. J., Darwish Murad, S., Heimbach, J. K., & Rosen, C. B. (2013). Liver transplantation for perihilar cholangiocarcinoma. Digestive Diseases, 31(1), 126-129. https://doi.org/10.1159/000347207