Liver Transplantation as a New Standard of Care in Patients With Perihilar Cholangiocarcinoma? Results From an International Benchmark Study. Issue 5 (27th November 2022)

• Record Type: Journal Article
• Authors: Breuer, Eva; Mueller, Matteo; Doyle, Majella B.; Yang, Liu; Darwish Murad, Sarwa; Anwar, Imran J.; Merani, Shaheed; Limkemann, Ashley; Jeddou, Heithem; Kim, Steven C.; López-López, Victor; Nassar, Ahmed; Hoogwater, Frederik J.H.; Vibert, Eric; De Oliveira, Michelle L.; Cherqui, Daniel; Porte, Robert J.; Magliocca, Joseph F.; Fischer, Lutz; Fondevila, Constantino; Zieniewicz, Krzysztof; Ramírez, Pablo; Foley, David P.; Boudjema, Karim; Schenk, Austin D.; Langnas, Alan N.; Knechtle, Stuart; Polak, Wojciech G.; Taner, C. Burcin; Chapman, William C.; Rosen, Charles B.; Gores, Gregory J.; Dutkowski, Philipp; Heimbach, Julie K.; Clavien, Pierre-Alain;
• Is Part Of: Annals of surgery. Volume 276:Issue 5(2022)
• Page Start: 846
• Page End: 853
• Publication Date: 2022-11-27
• Subjects: benchmarks -- CCI® -- complications -- liver transplantation -- Mayo-protocol -- outcomes -- perihilar cholangiocarcinoma; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000005641
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Objective: To define benchmark values for liver transplantation (LT) in patients with perihilar cholangiocarcinoma (PHC) enabling unbiased comparisons. Background: Transplantation for PHC is used with reluctance in many centers and even contraindicated in several countries. Although benchmark values for LT are available, there is a lack of specific data on LT performed for PHC. Methods: PHC patients considered for LT after Mayo-like protocol were analyzed in 17 reference centers in 2 continents over the recent 5-year period (2014–2018). The minimum follow-up was 1 year. Benchmark patients were defined as operated at high-volume centers (≥50 overall LT/year) after neoadjuvant chemoradiotherapy, with a tumor diameter <3 cm, negative lymph nodes, and with the absence of relevant comorbidities. Benchmark cutoff values were derived from the 75th to 25th percentiles of the median values of all benchmark centers. Results: One hundred thirty-four consecutive patients underwent LT after completion of the neoadjuvant treatment. Of those, 89.6% qualified as benchmark cases. Benchmark cutoffs were 90-day mortality ≤5.2%; comprehensive complication index at 1 year of ≤33.7; grade ≥3 complication rates ≤66.7%. These values were better than benchmark values for other indications of LT. Five-year disease-free survival was largely superior compared with a matched group of nodal negative patients undergoing curative liver resection (n=106) (62% vs 32%, P <0.001). Conclusion: This multicenter benchmark study demonstrates that LT offers excellent outcomes with superior oncological results in early stage PHC patients, even in candidates for surgery. This provocative observation should lead to a change in available therapeutic algorithms for PHC.