Original Article

Langenbeck's Archives of Surgery

, Volume 398, Issue 1, pp 71-77

Liver transplantation for hilar cholangiocarcinoma—a single-centre experience

  • Silke SchüleAffiliated withDepartment of General, Visceral and Vascular Surgery, University of Jena Email author 
  • , Annelore Altendorf-HofmannAffiliated withDepartment of General, Visceral and Vascular Surgery, University of Jena
  • , Frank UteßAffiliated withDepartment of General, Visceral and Vascular Surgery, University of Jena
  • , Falk RauchfußAffiliated withDepartment of General, Visceral and Vascular Surgery, University of Jena
  • , Martin FreesmeyerAffiliated withDepartment of Nuclear Medicine, University of Jena
  • , Thomas KnöselAffiliated withInstitute of Pathology, University of Jena
  • , Yves DittmarAffiliated withDepartment of General, Visceral and Vascular Surgery, University of Jena
  • , Utz SettmacherAffiliated withDepartment of General, Visceral and Vascular Surgery, University of Jena

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access

Abstract

Background

Cholangiocarcinoma is an infrequent malignancy, often unresectable at the time of diagnosis. Liver transplantation may offer a chance for cure, but results in the past have been disappointing, prompting transplant centres to adopt multimodal treatment protocols and extreme patient selection.

Purpose

This study was designed to evaluate the outcome of patients with irresectable hilar cholangiocarcinoma undergoing liver transplantation in order to determine criteria for patient selection.

Methods

We reviewed our prospective cancer registry for patients with hilar cholangiocarcinoma treated by transplantation since 1997. Data were evaluated regarding tumour location, stage, overall survival, recurrence rates and prognostic factors.

Results

Liver transplantation with lymphadenectomy was realised in 16 patients with hilar cholangiocarcinoma. Seven patients received a living donor graft. Lymph node metastases were found in eight patients with a median of 13 harvested nodes and had a statistically significant negative impact on overall survival irrespective of tumour size. Only one patient underwent neoadjuvant brachytherapy and developed fatal septic complications; 3- and 5-year survival rates were 63 and 50 % in lymph node-negative patients without neoadjuvant treatment.

Conclusions

Acceptable survival rates can be achieved by transplantation for hilar cholangiocarcinoma with lymph node metastases as the only exclusion criterion. We recommend staging laparotomy with lymphadenectomy along the common hepatic artery prior to liver transplantation.

Keywords

Hilar Cholangiocarcinoma Liver transplantation Multimodal therapy Prognosis