Contemporary trends and outcomes after liver transplantation and resection for intrahepatic cholangiocarcinoma

Liver transplantation (LT) has been shown to be superior to resection in highly selected patients with perihilar cholangiocarcinoma (CCA), yet has traditionally been contraindicated for intrahepatic CCA (iCCA). Herein, we aimed to examine contemporary trends and outcomes for surgical resection and L...

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Veröffentlicht in:Journal of gastrointestinal surgery 2024-05, Vol.28 (5), p.738-745
Hauptverfasser: Howell, Thomas Clark, Rhodin, Kristen E., Shaw, Brian, Bao, Jiayin, Kanu, Elishama, Masoud, Sabran, Bartholomew, Alex J., Gao, Qimeng, Anwar, Imran J., Ladowski, Joseph M., Nussbaum, Daniel P., Blazer, Dan G., Zani, Sabino, Allen, Peter J., Barbas, Andrew S., Lidsky, Michael E.
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Sprache:eng
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Zusammenfassung:Liver transplantation (LT) has been shown to be superior to resection in highly selected patients with perihilar cholangiocarcinoma (CCA), yet has traditionally been contraindicated for intrahepatic CCA (iCCA). Herein, we aimed to examine contemporary trends and outcomes for surgical resection and LT for iCCA. The National Cancer Database was queried for patients presenting with stage I-III iCCA between 2010 and 2018 who underwent resection or LT. Overall survival (OS) was compared with Kaplan-Meier and multivariable Cox proportional hazards methods stratified by management. Secondary analysis of patients undergoing transplant for CCA was performed with the United Network for Organ Sharing database. Of 2565 patients, 2412 (94.0%) underwent resection and 153 (5.96%) LT of whom 84 (54.9%) received neoadjuvant therapy. Utilization of LT remained between 3.9% and 7.8% annually. Unadjusted 5-year OS was higher for LT than resection (59.8% vs 39.9%, P = .0067), yet adjusted analysis revealed no significant difference in mortality (hazard ratio, 0.91; 95% CI, 0.66-1.27; P = .58). On secondary analysis including 437 patients with all subtypes of CCA, unadjusted 5-year OS was higher for non-CCA indications (79% vs 52%-54%, P 
ISSN:1091-255X
1873-4626
DOI:10.1016/j.gassur.2024.02.029