Publication: Liver Transplantation as a New Standard of Care in Patients With
Perihilar Cholangiocarcinoma? Results From an International
Benchmark Study
Authors
Breuer, Eva ; Mueller, Matteo ; Doyle, Majella B. ; Yang, Liu ; Darwish Murad, Sarwa ; Ramirez, Pablo ; Clavien, Pierre-Alain
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Publisher
Lippincott, Williams & Wilkins
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DOI
https://www.doi.org/10.1097/SLA.0000000000005641
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info:eu-repo/semantics/article
Description
© 2022 The Authors.
This document is the published version of a published work that appeared in final form Annals of Surgery
This document is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0
.
To access the final edited and published work see: https://www.doi.org/10.1097/SLA.0000000000005641
Abstract
Objective: To define benchmark values for liver transplantation (LT) in
patients with perihilar cholangiocarcinoma (PHC) enabling unbiased
comparisons.
Background: Transplantation for PHC is used with reluctance in many
centers and even contraindicated in several countries. Although
benchmark values for LT are available, there is a lack of specific data
on LT performed for PHC.
Methods: PHC patients considered for LT after Mayo-like protocol
were analyzed in 17 reference centers in 2 continents over the recent
5-year period (2014–2018). The minimum follow-up was 1 year.
Benchmark patients were defined as operated at high-volume centers
( ≥ 50 overall LT/year) after neoadjuvant chemoradiotherapy,
with a tumor diameter <3 cm, negative lymph nodes, and with the
absence of relevant comorbidities. Benchmark cutoff values were
derived from the 75th to 25th percentiles of the median values of all
benchmark centers.
Results: One hundred thirty-four consecutive patients underwent LT
after completion of the neoadjuvant treatment. Of those, 89.6%
qualified as benchmark cases. Benchmark cutoffs were 90-day mortality
≤ 5.2%; comprehensive complication index at 1 year of ≤ 33.7;
grade ≥ 3 complication rates ≤ 66.7%. These values were better than
benchmark values for other indications of LT. Five-year disease-free
survival was largely superior compared with a matched group of nodal
negative patients undergoing curative liver resection (n = 106) (62% vs
32%, P < 0.001).
Conclusion: This multicenter benchmark study demonstrates that LT
offers excellent outcomes with superior oncological results in early stage
PHC patients, even in candidates for surgery. This provocative observation
should lead to a change in available therapeutic algorithms for PHC.
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Citation
Annals of Surgery Vol. 276, nº 5, November 2022
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