Current Perspectives in Liver Transplantation for Perihilar Cholangiocarcinoma
Cholangiocarcinoma (CCA) encompasses all malignant neoplasms arising from the epithelial cells of the biliary tree. About 40% of CCAs are perihilar, involving the bile ducts distal to the second-order biliary branches and proximal to the cystic duct implant. About two-thirds of pCCAs are considered...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-03-01
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| Series: | Current Oncology |
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| Online Access: | https://www.mdpi.com/1718-7729/30/3/225 |
| _version_ | 1797612481658486784 |
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| author | Francesco Giovinazzo Marco Maria Pascale Francesca Cardella Matteo Picarelli Serena Molica Francesca Zotta Annamaria Martullo George Clarke Francesco Frongillo Antonio Grieco Salvatore Agnes |
| author_facet | Francesco Giovinazzo Marco Maria Pascale Francesca Cardella Matteo Picarelli Serena Molica Francesca Zotta Annamaria Martullo George Clarke Francesco Frongillo Antonio Grieco Salvatore Agnes |
| author_sort | Francesco Giovinazzo |
| collection | DOAJ |
| description | Cholangiocarcinoma (CCA) encompasses all malignant neoplasms arising from the epithelial cells of the biliary tree. About 40% of CCAs are perihilar, involving the bile ducts distal to the second-order biliary branches and proximal to the cystic duct implant. About two-thirds of pCCAs are considered unresectable at the time of diagnosis or exploration. When resective surgery is deemed unfeasible, liver transplantation (LT) could be an effective alternative. The overall survival rates after LT at 1 and 3 years are 91% and 81%, respectively. The overall five-year survival rate after transplantation is 73% (79% for patients with underlying PSC and 63% for de novo pCCA). Multicenter case series reported a 5-year disease-free survival rate of ~65%. However, different protocols, including neoadjuvant therapy, have been proposed. The scarcity of organ availability represents a crucial limiting factor in recommending LT preferentially in treating pCCA. Living donor transplantations and marginal cadaveric allografts have proven to be exciting options to overcome organ shortage. Management of jaundice and cholangitis is still challenging for these patients and could impact LT listing. Whether to adopt surgical resection or LT as standard-of-care in pCCA is still a matter of debate, and more prospective studies are needed. |
| first_indexed | 2024-03-11T06:41:50Z |
| format | Article |
| id | doaj.art-7016121ba5594bec8e27637985eb627b |
| institution | Directory Open Access Journal |
| issn | 1198-0052 1718-7729 |
| language | English |
| last_indexed | 2024-03-11T06:41:50Z |
| publishDate | 2023-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Current Oncology |
| spelling | doaj.art-7016121ba5594bec8e27637985eb627b2023-11-17T10:31:00ZengMDPI AGCurrent Oncology1198-00521718-77292023-03-013032942295310.3390/curroncol30030225Current Perspectives in Liver Transplantation for Perihilar CholangiocarcinomaFrancesco Giovinazzo0Marco Maria Pascale1Francesca Cardella2Matteo Picarelli3Serena Molica4Francesca Zotta5Annamaria Martullo6George Clarke7Francesco Frongillo8Antonio Grieco9Salvatore Agnes10General Surgery and Liver Transplant Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, ItalyGeneral Surgery and Liver Transplant Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, ItalySurgical Oncology of Gastrointestinal Tract Unit, Vanvitelli University, 80138 Naples, ItalyGeneral Surgery and Liver Transplant Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, ItalyGeneral Surgery and Liver Transplant Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, ItalyGeneral Surgery and Liver Transplant Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, ItalyGeneral Surgery and Liver Transplant Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, ItalyLiver Unit, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, UKGeneral Surgery and Liver Transplant Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, ItalyGeneral Surgery and Liver Transplant Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, ItalyGeneral Surgery and Liver Transplant Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, ItalyCholangiocarcinoma (CCA) encompasses all malignant neoplasms arising from the epithelial cells of the biliary tree. About 40% of CCAs are perihilar, involving the bile ducts distal to the second-order biliary branches and proximal to the cystic duct implant. About two-thirds of pCCAs are considered unresectable at the time of diagnosis or exploration. When resective surgery is deemed unfeasible, liver transplantation (LT) could be an effective alternative. The overall survival rates after LT at 1 and 3 years are 91% and 81%, respectively. The overall five-year survival rate after transplantation is 73% (79% for patients with underlying PSC and 63% for de novo pCCA). Multicenter case series reported a 5-year disease-free survival rate of ~65%. However, different protocols, including neoadjuvant therapy, have been proposed. The scarcity of organ availability represents a crucial limiting factor in recommending LT preferentially in treating pCCA. Living donor transplantations and marginal cadaveric allografts have proven to be exciting options to overcome organ shortage. Management of jaundice and cholangitis is still challenging for these patients and could impact LT listing. Whether to adopt surgical resection or LT as standard-of-care in pCCA is still a matter of debate, and more prospective studies are needed.https://www.mdpi.com/1718-7729/30/3/225cholangiocarcinomaliver transplantationbiliary tumourreviewbile duct neoplasm |
| spellingShingle | Francesco Giovinazzo Marco Maria Pascale Francesca Cardella Matteo Picarelli Serena Molica Francesca Zotta Annamaria Martullo George Clarke Francesco Frongillo Antonio Grieco Salvatore Agnes Current Perspectives in Liver Transplantation for Perihilar Cholangiocarcinoma Current Oncology cholangiocarcinoma liver transplantation biliary tumour review bile duct neoplasm |
| title | Current Perspectives in Liver Transplantation for Perihilar Cholangiocarcinoma |
| title_full | Current Perspectives in Liver Transplantation for Perihilar Cholangiocarcinoma |
| title_fullStr | Current Perspectives in Liver Transplantation for Perihilar Cholangiocarcinoma |
| title_full_unstemmed | Current Perspectives in Liver Transplantation for Perihilar Cholangiocarcinoma |
| title_short | Current Perspectives in Liver Transplantation for Perihilar Cholangiocarcinoma |
| title_sort | current perspectives in liver transplantation for perihilar cholangiocarcinoma |
| topic | cholangiocarcinoma liver transplantation biliary tumour review bile duct neoplasm |
| url | https://www.mdpi.com/1718-7729/30/3/225 |
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