Tchilikidi KY. Ex vivo liver resection and auto-transplantation and special systemic therapy in perihilar cholangiocarcinoma treatment. World J Gastrointest Surg 2024; 16(3): 635-640 [PMID: 38577079 DOI: 10.4240/wjgs.v16.i3.635]
Corresponding Author of This Article
Konstantin Y Tchilikidi, MD, Assistant Professor, Department of Surgery with Postgraduate Education, Altai State Medical University, Krasnoarmeysky avenue 131-10, Barnaul 656031, Russia. kt80876@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Editorial
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 Gastrointest Surg. Mar 27, 2024; 16(3): 635-640 Published online Mar 27, 2024. doi: 10.4240/wjgs.v16.i3.635
Ex vivo liver resection and auto-transplantation and special systemic therapy in perihilar cholangiocarcinoma treatment
Konstantin Y Tchilikidi
Konstantin Y Tchilikidi, Department of Surgery with Postgraduate Education, Altai State Medical University, Barnaul 656031, Russia
Author contributions: Tchilikidi KY is the sole author of this manuscript.
Conflict-of-interest statement: The author reports 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: Konstantin Y Tchilikidi, MD, Assistant Professor, Department of Surgery with Postgraduate Education, Altai State Medical University, Krasnoarmeysky avenue 131-10, Barnaul 656031, Russia. kt80876@gmail.com
Received: November 16, 2023 Peer-review started: November 16, 2023 First decision: December 17, 2023 Revised: December 26, 2023 Accepted: February 18, 2024 Article in press: February 18, 2024 Published online: March 27, 2024
Abstract
This editorial contains comments on the article “Systematic sequential therapy for ex vivo liver resection and autotransplantation: A case report and review of literature” in the recent issue of World Journal of Gastrointestinal Surgery. It points out the actuality and importance of the article and focuses primarily on the role and place of ex vivo liver resection and autotransplantation (ELRAT) and systemic therapy, underlying molecular mechanisms for targeted therapy in perihilar cholangiocarcinoma (pCCA) management. pCCA is a tough malignancy with a high proportion of advanced disease at the time of diagnosis. The only curative option is radical surgery. Surgical excision and reconstruction become extremely complicated and not always could be performed even in localized disease. On the other hand, ELRAT takes its place among surgical options for carefully selected pCCA patients. In advanced disease, systemic therapy becomes a viable option to prolong survival. This editorial describes current possibilities in chemotherapy and reveals underlying mechanisms and projections in targeted therapy with kinase inhibitors and immunotherapy in both palliative and adjuvant settings. Fibroblast grow factor and fibroblast grow factor receptor, human epidermal growth factor receptor 2, isocitrate dehydrogenase, and protein kinase cAMP activated catalytic subunit alpha (PRKACA) and beta (PRKACB) pathways have been actively investigated in CCA in last years. Several agents were introduced and approved by the Food and Drug Administration. They all demonstrated meaningful activity in CCA patients with no global change in outcomes. That is why every successfully treated patient counts, especially those with advanced disease. In conclusion, pCCA is still hard to treat due to late diagnosis and extremely complicated surgical options. ELRAT also brings some hope, but it could be performed in very carefully selected patients. Advanced disease requires systemic anticancer treatment, which is supposed to be individualized according to the genetic and molecular features of cancer cells. Targeted therapy in combination with chemo-immunotherapy could be effective in susceptible patients.
Core Tip: Perihilar cholangiocarcinoma is still hard to treat due to late diagnosis and extremely complicated surgical options. Ex vivo liver resection and autotransplantation brings some hope, but it could be performed only in carefully selected patients. Advanced disease requires systemic anticancer treatment, which is supposed to be individualized according to the genetic and molecular features of cancer cells. Targeted therapy in combination with chemo-immunotherapy could be effective in susceptible patients.
