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