Comparison of resection versus liver transplantation for intrahepatic cholangiocarcinoma: Past, present, and future directions

Sudha Kodali, Ashton A. Connor, Souhail Thabet, Elizabeth W. Brombosz, R. Mark Ghobrial

Research output: Contribution to journalReview articlepeer-review

5 Scopus citations

Abstract

Intrahepatic cholangiocarcinoma (iCCA) is a rare biliary tract cancer with high mortality rate. Complete resection of the iCCA lesion is the first choice of treatment, with good prognosis after margin-negative resection. Unfortunately, only 12%-40% of patients are eligible for resection at presentation due to cirrhosis, portal hypertension, or large tumor size. Liver transplantation (LT) offers margin-negative iCCA extirpation for patients with unresectable tumors. Initially, iCCA was a contraindication for LT until size-based selection criteria were introduced to identify patients with satisfied post-LT outcomes. Recent studies have shown that tumor biology-based selection can yield high post-LT survival in patients with locally advanced iCCA. Another selection criterion is the tumor response to neoadjuvant therapy. Patients with response to neoadjuvant therapy have better outcomes after LT compared with those without tumor response to neoadjuvant therapy. Another index that helps predict the treatment outcome is the biomarker. Improved survival outcomes have also opened the door for living donor LT for iCCA. Patients undergoing LT for iCCA now have statistically similar survival rates as patients undergoing resection. The combination of surgery and locoregional and systemic therapies improves the prognosis of iCCA patients.

Original languageEnglish (US)
Pages (from-to)129-138
Number of pages10
JournalHepatobiliary and Pancreatic Diseases International
Volume23
Issue number2
Early online dateJul 23 2023
DOIs
StateE-pub ahead of print - Jul 23 2023

Keywords

  • Cholangiocarcinoma
  • Hepatectomy
  • Liver neoplasm
  • Liver transplantation
  • Transplant oncology

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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