Borakati A, Froghi F, Bhogal RH, Mavroeidis VK. Liver transplantation in the management of cholangiocarcinoma: Evolution and contemporary advances. World J Gastroenterol 2023; 29(13): 1969-1981 [PMID: 37155529 DOI: 10.3748/wjg.v29.i13.1969]
Corresponding Author of This Article
Vasileios K Mavroeidis, MD, MSc, FRCS, FACS, FICS, MFSTEd, Surgeon, Department of Academic Surgery, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, United Kingdom. vasileios.mavroeidis@nhs.net
Research Domain of This Article
Transplantation
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Apr 7, 2023; 29(13): 1969-1981 Published online Apr 7, 2023. doi: 10.3748/wjg.v29.i13.1969
Liver transplantation in the management of cholangiocarcinoma: Evolution and contemporary advances
Aditya Borakati, Farid Froghi, Ricky H Bhogal, Vasileios K Mavroeidis
Aditya Borakati, Farid Froghi, Department of HPB and Liver Transplantation Surgery, Royal Free Hospital NHS Foundation Trust, London NW3 2QG, United Kingdom
Ricky H Bhogal, Vasileios K Mavroeidis, Department of Academic Surgery, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, United Kingdom
Author contributions: Mavroeidis VK conceptualised and designed the study; Borakati A and Mavroeidis VK did the literature search; Borakati A and Froghi F did the analysis, interpretation of data and drafted the original manuscript; Bhogal RH and Mavroeidis VK supervised and made critical revisions; All authors prepared the final draft and approved the final version.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: 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/
Corresponding author: Vasileios K Mavroeidis, MD, MSc, FRCS, FACS, FICS, MFSTEd, Surgeon, Department of Academic Surgery, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, United Kingdom. vasileios.mavroeidis@nhs.net
Received: December 6, 2022 Peer-review started: December 6, 2022 First decision: February 1, 2023 Revised: February 10, 2023 Accepted: March 21, 2023 Article in press: March 21, 2023 Published online: April 7, 2023
Abstract
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.
Core Tip: Cholangiocarcinoma (CCA) is an aggressive malignancy with poor prognosis. Radical surgical resection with clear margins may offer a chance of cure but is frequently not possible due to locally advanced disease. In the last two decades, within specific criteria, a protocolised combination of neoadjuvant chemoradiation and orthotopic liver transplantation (LT) has produced excellent results in patients with perihilar CCA, while favourable results have been shown with LT in early intrahepatic CCA in recent years. We review the history and contemporary advances of LT in CCA and discuss future perspectives.
