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Transplantation Versus Resection for Hilar Cholangiocarcinoma An Argument for Shifting Treatment Paradigms for Resectable Disease Ethun, C. G., Lopez-Aguiar, A. G., Anderson, D. J., Adams, A. B., Fields, R. C., Doyle, M. B., Chapman, W. C., Krasnick, B. A., Weber, S. M., Mezrich, J. D., Salem, A., Pawlik, T. M., Poultsides, G., Tran, T. B., Idrees, K., Isom, C. A., Martin, R. G., Scoggins, C. R., Shen, P., Mogal, H. D., Schmidt, C., Beal, E., Hatzaras, I., Shenoy, R., Cardona, K., Maithel, S. K. LIPPINCOTT WILLIAMS & WILKINS. 2018: 797–805

Abstract

To investigate the influence of type of surgery (transplant vs resection) on overall survival (OS) in patients with hilar cholangiocarcinoma (H-CCA).Outcomes after resection for H-CCA are poor, yet transplantation is currently only reserved for well-selected patients with unresectable disease.All patients with H-CCA who underwent resection from 2000 to 2015 at 10 institutions were included. Three institutions additionally had active H-CCA transplant protocols with similar selection criteria over similar time periods.Of 304 patients with suspected H-CCA, 234 underwent attempted resection and 70 were enrolled in a transplant protocol. Excluding incomplete/R2 resections (n = 43), patients who were enrolled, but did not undergo transplant (n = 24), and transplants without confirmed H-CCA diagnoses (n = 5), 191 patients underwent curative-intent resection and 41 curative-intent transplant. Compared with resection, transplant patients were younger (52 vs 65 years; P < 0.001), and more frequently had primary sclerosing cholangitis (PSC; 61% vs 2%; P < 0.001) and received chemotherapy and/or radiation (98% vs 57%; P < 0.001). Groups were otherwise similar in demographics and comorbidities. Patients who underwent transplant for confirmed H-CCA diagnosis had improved OS compared with resection (3-year: 72% vs 33%; 5-year: 64% vs 18%; P < 0.001). Among patients who underwent resection for tumors <3?cm with lymph-node negative disease, and excluding PSC patients, transplant was still associated with improved OS (3-year: 54% vs 44%; 5-year: 54% vs 29%; P = 0.03). Transplant remained associated with improved survival on intention-to-treat analysis, even after accounting for tumor size, lymph node status, and PSC (P = 0.049).Resection for hilar cholangiocarcinoma that meets criteria for transplantation (<3?cm, lymph-node negative disease) is associated with substantially decreased survival compared to transplant for the same criteria with unresectable disease. Prospective trials are needed and justified.

View details for PubMedID 29064885