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Liver transplantation in the management of cholangiocarcinoma: Evolution and contemporary advances

Cholangiocarcinoma (CCA) is an aggressive malignancy arising from the biliary epithelium. It may occur at any location along the biliary tree with the perihilar area being the most common. Prognosis is poor with 5-year overall survival at less than 10%, typically due to unresectable disease at prese...

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Autores principales: Borakati, Aditya, Froghi, Farid, Bhogal, Ricky H, Mavroeidis, Vasileios K
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10122785/
https://www.ncbi.nlm.nih.gov/pubmed/37155529
http://dx.doi.org/10.3748/wjg.v29.i13.1969
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author Borakati, Aditya
Froghi, Farid
Bhogal, Ricky H
Mavroeidis, Vasileios K
author_facet Borakati, Aditya
Froghi, Farid
Bhogal, Ricky H
Mavroeidis, Vasileios K
author_sort Borakati, Aditya
collection PubMed
description Cholangiocarcinoma (CCA) is an aggressive malignancy arising from the biliary epithelium. It may occur at any location along the biliary tree with the perihilar area being the most common. Prognosis is poor with 5-year overall survival at less than 10%, typically due to unresectable disease at presentation. Radical surgical resection with clear margins offers a chance of cure in patients with resectable tumours, but is frequently not possible due to locally advanced disease. On the other hand, orthotopic liver transplantation (LT) allows for a radical and potentially curative resection for these patients, but has been historically controversial due to the limited supply of donor grafts and previously poor outcomes. In patients with perihilar CCA, within specific criteria and following the implementation of a protocol combining neoadjuvant chemoradiation and LT, excellent results have been achieved in the last decades, resulting in its increasing acceptance as an indication for LT and the standard of care in several centres with significant experience. However, in intrahepatic CCA, the role of LT remains controversial and owing to dismal previous results it is not an accepted indication. Nevertheless, more recent studies have demonstrated favourable results with LT in early intrahepatic CCA, indicating that, under defined criteria, its role may increase in the future. This review highlights the history and contemporary advances of LT in CCA, with particular focus on the improving outcomes of LT in intrahepatic and perihilar CCA and future perspectives.
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spelling pubmed-101227852023-04-24 Liver transplantation in the management of cholangiocarcinoma: Evolution and contemporary advances Borakati, Aditya Froghi, Farid Bhogal, Ricky H Mavroeidis, Vasileios K World J Gastroenterol Minireviews Cholangiocarcinoma (CCA) is an aggressive malignancy arising from the biliary epithelium. It may occur at any location along the biliary tree with the perihilar area being the most common. Prognosis is poor with 5-year overall survival at less than 10%, typically due to unresectable disease at presentation. Radical surgical resection with clear margins offers a chance of cure in patients with resectable tumours, but is frequently not possible due to locally advanced disease. On the other hand, orthotopic liver transplantation (LT) allows for a radical and potentially curative resection for these patients, but has been historically controversial due to the limited supply of donor grafts and previously poor outcomes. In patients with perihilar CCA, within specific criteria and following the implementation of a protocol combining neoadjuvant chemoradiation and LT, excellent results have been achieved in the last decades, resulting in its increasing acceptance as an indication for LT and the standard of care in several centres with significant experience. However, in intrahepatic CCA, the role of LT remains controversial and owing to dismal previous results it is not an accepted indication. Nevertheless, more recent studies have demonstrated favourable results with LT in early intrahepatic CCA, indicating that, under defined criteria, its role may increase in the future. This review highlights the history and contemporary advances of LT in CCA, with particular focus on the improving outcomes of LT in intrahepatic and perihilar CCA and future perspectives. Baishideng Publishing Group Inc 2023-04-07 2023-04-07 /pmc/articles/PMC10122785/ /pubmed/37155529 http://dx.doi.org/10.3748/wjg.v29.i13.1969 Text en ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved. https://creativecommons.org/licenses/by-nc/4.0/This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
spellingShingle Minireviews
Borakati, Aditya
Froghi, Farid
Bhogal, Ricky H
Mavroeidis, Vasileios K
Liver transplantation in the management of cholangiocarcinoma: Evolution and contemporary advances
title Liver transplantation in the management of cholangiocarcinoma: Evolution and contemporary advances
title_full Liver transplantation in the management of cholangiocarcinoma: Evolution and contemporary advances
title_fullStr Liver transplantation in the management of cholangiocarcinoma: Evolution and contemporary advances
title_full_unstemmed Liver transplantation in the management of cholangiocarcinoma: Evolution and contemporary advances
title_short Liver transplantation in the management of cholangiocarcinoma: Evolution and contemporary advances
title_sort liver transplantation in the management of cholangiocarcinoma: evolution and contemporary advances
topic Minireviews
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10122785/
https://www.ncbi.nlm.nih.gov/pubmed/37155529
http://dx.doi.org/10.3748/wjg.v29.i13.1969
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