Abstract
Liver transplantation for hilar cholangiocarcinoma is successful only when combined with careful patient selection, neoadjuvant radiotherapy with chemosensitization, and pretransplant operative staging. This approach is best suited for patients with early stage cholangiocarcinoma arising in the setting of primary sclerosing cholangitis (PSC) or for patients with unresectable cholangiocarcinoma arising de novo. The use of neoadjuvant radiotherapy necessitates modification of standard liver transplantation technique. Higher incidences of hepatic artery thrombosis and portal vein stenosis require use of aortic jump grafts during deceased donor transplantation and vigilant long-term allograft surveillance after transplantation. All patients require complete resection of the extrahepatic duct and a Roux-en-Y biliary reconstruction. Unanticipated common bile duct involvement detected (in about 10% of PSC patients) during hepatectomy can require pancreaticoduodenectomy in order to achieve complete eradication of cancer. Neoadjuvant therapy and the presence of a hilar cholangiocarcinoma require specific technical modifications in order to achieve the best possible long-term results.
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Jadlowiec, C.C., Rosen, C.B. (2017). Transplantation for Hilar Cholangiocarcinoma. In: Pawlik, T., Weber, S., Gamblin, T. (eds) Case-Based Lessons in the Management of Complex Hepato-Pancreato-Biliary Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-50868-9_20
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DOI: https://doi.org/10.1007/978-3-319-50868-9_20
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