Outcomes of Liver Transplant Versus Partial Hepatectomy for Perihilar Cholangiocarcinoma Patients Requiring Arterial Reconstruction.

Authors

Edoardo Poletto, Pim B Olthof, Andrea Ruzzenente, Jean-Philippe Adam, Ian P J Alwayn, Emmanuel Boleslawski, Marieke T de Boer, Alexandre Chebaro, Laurence Chiche, Cristina Dopazo, Jeroen Dubbeld, Joris I Erdmann, Abdul Hakeem, Minneke J Coenraad, Hendrien Kuipers, Jean-Yves Mabrut, Charlotte Maulat, Shishir K Maithel, Vincent E de Meijer, Kayvan Mohkam, Sarwa Darwish Murad, Fabrice Muscari, Jens Rolinger, Wojciech G Polak, Michel Rayar, Francesca Ratti, Fabien Robin, Andreas A Schnitzbauer, Ernesto Sparrelid, Frederike G I Van Vilsteren, Robert J Porte, Frederik J H Hoogwater, Bas Groot Koerkamp, Perihilar Cholangiocarcinoma Collaboration Group

Published in

Liver international : official journal of the International Association for the Study of the Liver. Volume 46. Issue 7. Pages e70729.

Abstract

Liver resection (LR) and orthotopic liver transplantation (OLT) are therapeutic options for locally advanced perihilar cholangiocarcinoma (pCCA) requiring hepatic artery reconstruction (HAR). This study aimed to compare short- and long-term outcomes of LR and OLT. Outcomes were major vascular complications, 90-day mortality, overall survival (OS) and recurrence-free survival (RFS).
A cohort of patients undergoing LR with HAR from 10 Western centres was compared with an OLT cohort comprising patients who received or did not receive neoadjuvant chemoradiotherapy (NACR).
109 patients, 60 LR and 49 OLT (22 OLT no-NACR and 27 OLT NACR) were included. LR patients were older and had fewer Bismuth type 4 tumours (38.3% vs. 69.4%, p = 0.009). Positive margins (49.2% vs. 6.5%, p < 0.001) and lymph nodes (54.2% vs. 32.4%, p = 0.058) were found more frequently in LR patients. No differences were found between LR and OLT in major (40% vs. 46.9%, p = 0.56) and vascular complications (23.3% vs. 28.6%, p = 0.66); NACR was an independent prognostic factor for vascular complications (OR 2.63, 95% CI 1.03-6.70, p = 0.043). 90-day mortality (15% for LR vs. 10.2% for OLT, p = 0.57) and 5-year OS (HR 0.68, 95% CI 0.40-1.17, p = 0.17) were similar. Median OS after LR versus OLT was higher but not significant (24 vs. 40 months, p = 0.13). OLT had better 5-year RFS (HR 0.52, 95% CI 0.29-0.96, p = 0.035) than LR. R1 resection (HR 2.07, 95% CI 1.03-4.18, p = 0.041) and perineural invasion (HR 3.64, 95% CI 1.09-12.16, p = 0.035) were independent prognostic factors for RFS.
LR and OLT for locally advanced pCCA had similar rates of major complications and post-operative mortality, but NACR was associated with increased vascular complications. Survival was difficult to compare in the groups due to their heterogeneity, but OLT, especially with NACR, seems to give better results than LR.

PMID:
42324714
Bibliographic data and abstract were imported from PubMed on 22 Jun 2026.

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