Neoadjuvant/adjuvant therapy for liver resection and transplantation

Long-term control of hilar cholangiocarcinoma (CCA) and extrahepatic cholangiocarcinoma (CCA) in general can only be obtained with complete surgical removal of all neoplastic tissue in toto either via surgical resection or transplantation [1]. Most investigators have demonstrated that complete surgical resection with negative margins (R0 resection) is the most important determinant of survival in hilar CCA [2, 3]. However, only a minority of patients are able to receive an oncologic resection [4]. Moreover, even after complete resection with negative margins the overall survival of patients with hilar CCA has been reported to range from 30 % to 52 % [5]. Murakami et al. [6] suggested that patients with UICC stage II and III CCAs to receive adjuvant therapy due to the high recurrence rate compare to Stage I tumors. The most common site of first recurrence after oncologic resection of hilar CCA is locoregional which often leads to potentially fatal complications such as biliary obstruction, sepsis and liver failure [4, 7, 8]. Only approximately 10-15 % of patients develop distant metastases before locoregional recurrence [7].