Comparison between liver transplantation and resection for hilar cholangiocarcinoma: A systematic review and meta-analysis.
<h4>Background</h4>Hilar cholangiocarcinoma (hCCA) is a rare and aggressive malignancy with R0 resection being currently the only option for long-term survival. With the improvement in the outcomes of liver transplantation (LT), the indications for LT have expanded to include other malig...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2019-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0220527 |
| _version_ | 1828955401575464960 |
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| author | Dimitrios Moris Ioannis D Kostakis Nikolaos Machairas Anastasia Prodromidou Diamantis I Tsilimigras Kadiyala V Ravindra Debra L Sudan Stuart J Knechtle Andrew S Barbas |
| author_facet | Dimitrios Moris Ioannis D Kostakis Nikolaos Machairas Anastasia Prodromidou Diamantis I Tsilimigras Kadiyala V Ravindra Debra L Sudan Stuart J Knechtle Andrew S Barbas |
| author_sort | Dimitrios Moris |
| collection | DOAJ |
| description | <h4>Background</h4>Hilar cholangiocarcinoma (hCCA) is a rare and aggressive malignancy with R0 resection being currently the only option for long-term survival. With the improvement in the outcomes of liver transplantation (LT), the indications for LT have expanded to include other malignant tumors, such as hCCA. The aim of the present analysis is to demonstrate and critically evaluate the outcomes of LT compared to resection with curative intent in patients with hCCA.<h4>Methods</h4>We systematically searched the literature for articles published up to May 2018. The following algorithm was applied ((hilar cholangiocarcinoma) OR (perihilar cholangiocarcinoma) OR klatskin$ OR (bile duct neoplasm) OR cholangiocarcinoma) AND (transplant$ OR graft$).<h4>Results</h4>Neoadjuvant treatment with chemotherapy and radiation therapy was far more common in the LT group, with very few patients having received preoperative therapy in the resection group (p = 0.0005). Moreover, length of hospital stay was shorter after LT than after resection (p<0.00001). In contrast, no difference was found between the two treatment methods concerning postoperative mortality (p = 0.57). There was a trend towards longer overall survival after LT in comparison with resection. This was not obvious in the first year postoperatively, however, the advantage of LT over resection became obvious at 3 years after the operation (p = 0.02).<h4>Conclusions</h4>In non-disseminated unresectable tumors, LT seems to have a non-inferior survival. In the same patients, neoadjuvant chemoradiotherapy and/or strict selection criteria may contribute to superior survival outcomes compared to curative-intent resection. Due to the scarcity of level 1 evidence, it remains unclear whether LT should be increasingly considered for technically resectable early stage hCCA. |
| first_indexed | 2024-12-14T07:49:36Z |
| format | Article |
| id | doaj.art-fb77c33b4f6241bcae546d6a2922a859 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-14T07:49:36Z |
| publishDate | 2019-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-fb77c33b4f6241bcae546d6a2922a8592022-12-21T23:10:45ZengPublic Library of Science (PLoS)PLoS ONE1932-62032019-01-01147e022052710.1371/journal.pone.0220527Comparison between liver transplantation and resection for hilar cholangiocarcinoma: A systematic review and meta-analysis.Dimitrios MorisIoannis D KostakisNikolaos MachairasAnastasia ProdromidouDiamantis I TsilimigrasKadiyala V RavindraDebra L SudanStuart J KnechtleAndrew S Barbas<h4>Background</h4>Hilar cholangiocarcinoma (hCCA) is a rare and aggressive malignancy with R0 resection being currently the only option for long-term survival. With the improvement in the outcomes of liver transplantation (LT), the indications for LT have expanded to include other malignant tumors, such as hCCA. The aim of the present analysis is to demonstrate and critically evaluate the outcomes of LT compared to resection with curative intent in patients with hCCA.<h4>Methods</h4>We systematically searched the literature for articles published up to May 2018. The following algorithm was applied ((hilar cholangiocarcinoma) OR (perihilar cholangiocarcinoma) OR klatskin$ OR (bile duct neoplasm) OR cholangiocarcinoma) AND (transplant$ OR graft$).<h4>Results</h4>Neoadjuvant treatment with chemotherapy and radiation therapy was far more common in the LT group, with very few patients having received preoperative therapy in the resection group (p = 0.0005). Moreover, length of hospital stay was shorter after LT than after resection (p<0.00001). In contrast, no difference was found between the two treatment methods concerning postoperative mortality (p = 0.57). There was a trend towards longer overall survival after LT in comparison with resection. This was not obvious in the first year postoperatively, however, the advantage of LT over resection became obvious at 3 years after the operation (p = 0.02).<h4>Conclusions</h4>In non-disseminated unresectable tumors, LT seems to have a non-inferior survival. In the same patients, neoadjuvant chemoradiotherapy and/or strict selection criteria may contribute to superior survival outcomes compared to curative-intent resection. Due to the scarcity of level 1 evidence, it remains unclear whether LT should be increasingly considered for technically resectable early stage hCCA.https://doi.org/10.1371/journal.pone.0220527 |
| spellingShingle | Dimitrios Moris Ioannis D Kostakis Nikolaos Machairas Anastasia Prodromidou Diamantis I Tsilimigras Kadiyala V Ravindra Debra L Sudan Stuart J Knechtle Andrew S Barbas Comparison between liver transplantation and resection for hilar cholangiocarcinoma: A systematic review and meta-analysis. PLoS ONE |
| title | Comparison between liver transplantation and resection for hilar cholangiocarcinoma: A systematic review and meta-analysis. |
| title_full | Comparison between liver transplantation and resection for hilar cholangiocarcinoma: A systematic review and meta-analysis. |
| title_fullStr | Comparison between liver transplantation and resection for hilar cholangiocarcinoma: A systematic review and meta-analysis. |
| title_full_unstemmed | Comparison between liver transplantation and resection for hilar cholangiocarcinoma: A systematic review and meta-analysis. |
| title_short | Comparison between liver transplantation and resection for hilar cholangiocarcinoma: A systematic review and meta-analysis. |
| title_sort | comparison between liver transplantation and resection for hilar cholangiocarcinoma a systematic review and meta analysis |
| url | https://doi.org/10.1371/journal.pone.0220527 |
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