Transplantation for hilar cholangiocarcinoma

✍ Scribed by Julie K. Heimbach; Michael G. Haddock; Steven R. Alberts; Scott L. Nyberg; Michael B. Ishitani; Charles B. Rosen; Gregory J. Gores

• Publisher: John Wiley and Sons
• Year: 2004
• Tongue: English
• Weight: 134 KB
• Volume: 10
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.20266

✦ Synopsis

Key

Points 1. Patients with primary sclerosing cholangitis (PSC) have a 8 to 12% risk of developing cholangiocarcinoma (CCA). 2. Cytologic techniques for aneuploidy such as digital image analysis and fluorescence in situ hybridization increase the detection rate for CCA. 3. Survival following resection for CCA is 20% to 40% at 5 years. 4. Survival following liver transplantation for unresectable, perihilar CCAs, mass lesion if present <3 cm, is greater than 80% at 5 years. 5. Patients with intrahepatic CCAs are not eligible for liver transplantation. (Liver Transpl 2004;10: S65-S68.)

C holangiocarcinoma (CCA) is a highly malig- nant neoplasm that arises from the bile duct epithelia. Approximately 3,500 new cases per year are diagnosed, with a prevalence of 1.2 in 100,000. 1 Although CCA can occur anywhere along the intraor extrahepatic bile ducts, it most commonly (60%) occurs in the perihilar region of the liver at the confluence of the right and left hepatic ducts (Klatskintype tumor). Typically, perihilar CCA is a slow growing tumor that invades adjacent neural, lymphatic, and hepatic tissue. Subepithelial spread beyond the growth tumor margin is common. Rather than growing as a mass lesion, the tumor frequently grows alongside the bile duct, evidence for a potential tropism between this tumor and bile. Regional lymphatic spread is quite common, however, in advanced cases.