Liver transplantation with neoadjuvant chemoradiation is more effective than resection for hilar cholangiocarcinoma

David J. Rea, Julie K. Heimbach, Charles Burke Rosen, Michael G. Haddock, Steven R. Alberts, Walter K. Kremers, Gregory J. Gores, David M. Nagorney, John P. Roberts, Charles B. Rosen, Roger L. Jenkins, Byers Wendell Shaw Jr, Jean C. Emond, William J. Wall

Research output: Contribution to journalArticle

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Abstract

Objective: Compare survival after neoadjuvant therapy and liver transplantation with survival after resection for patients with hilar CCA. Summary Background Data: We developed a protocol combining neoadjuvant radiotherapy, chemosensitization, and orthotopic liver transplantation for patients with operatively confirmed stage I and II hilar CCA in 1993. Since then, patients with unresectable CCA or CCA arising in the setting of PSC have been enrolled in the transplant protocol. Patients with tumors amenable to resection have undergone excision of the extrahepatic duct with lymphadenectomy and liver resection. Methods: We reviewed our experience between January 1993 and August 2004 and compared patient survival between the treatment groups. Results: Seventy-one patients entered the transplant treatment protocol and 38 underwent liver transplantation. Fifty-four patients were explored for resection. Twenty-six (48%) underwent resection, and 28 (52%) had unresectable disease. One-, 3-, and 5-year patient survival were 92%, 82%, and 82% after transplantation and 82%, 48%, and 21% after resection (P = 0.022). There were fewer recurrences in the transplant patients (13% versus 27%). Conclusions: Liver transplantation with neoadjuvant chemoradiation achieved better survival with less recurrence than conventional resection and should be considered as an alternative to resection for patients with localized, node-negative hilar CCA.

Original languageEnglish (US)
Pages (from-to)451-461
Number of pages11
JournalAnnals of surgery
Volume242
Issue number3
DOIs
StatePublished - Sep 1 2005

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Klatskin Tumor
Liver Transplantation
Survival
Transplants
Recurrence
Neoadjuvant Therapy
Clinical Protocols
Lymph Node Excision

ASJC Scopus subject areas

  • Surgery

Cite this

Rea, D. J., Heimbach, J. K., Rosen, C. B., Haddock, M. G., Alberts, S. R., Kremers, W. K., ... Wall, W. J. (2005). Liver transplantation with neoadjuvant chemoradiation is more effective than resection for hilar cholangiocarcinoma. Annals of surgery, 242(3), 451-461. https://doi.org/10.1097/01.sla.0000179678.13285.fa

Liver transplantation with neoadjuvant chemoradiation is more effective than resection for hilar cholangiocarcinoma. / Rea, David J.; Heimbach, Julie K.; Rosen, Charles Burke; Haddock, Michael G.; Alberts, Steven R.; Kremers, Walter K.; Gores, Gregory J.; Nagorney, David M.; Roberts, John P.; Rosen, Charles B.; Jenkins, Roger L.; Shaw Jr, Byers Wendell; Emond, Jean C.; Wall, William J.

In: Annals of surgery, Vol. 242, No. 3, 01.09.2005, p. 451-461.

Research output: Contribution to journalArticle

Rea, DJ, Heimbach, JK, Rosen, CB, Haddock, MG, Alberts, SR, Kremers, WK, Gores, GJ, Nagorney, DM, Roberts, JP, Rosen, CB, Jenkins, RL, Shaw Jr, BW, Emond, JC & Wall, WJ 2005, 'Liver transplantation with neoadjuvant chemoradiation is more effective than resection for hilar cholangiocarcinoma', Annals of surgery, vol. 242, no. 3, pp. 451-461. https://doi.org/10.1097/01.sla.0000179678.13285.fa
Rea, David J. ; Heimbach, Julie K. ; Rosen, Charles Burke ; Haddock, Michael G. ; Alberts, Steven R. ; Kremers, Walter K. ; Gores, Gregory J. ; Nagorney, David M. ; Roberts, John P. ; Rosen, Charles B. ; Jenkins, Roger L. ; Shaw Jr, Byers Wendell ; Emond, Jean C. ; Wall, William J. / Liver transplantation with neoadjuvant chemoradiation is more effective than resection for hilar cholangiocarcinoma. In: Annals of surgery. 2005 ; Vol. 242, No. 3. pp. 451-461.
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abstract = "Objective: Compare survival after neoadjuvant therapy and liver transplantation with survival after resection for patients with hilar CCA. Summary Background Data: We developed a protocol combining neoadjuvant radiotherapy, chemosensitization, and orthotopic liver transplantation for patients with operatively confirmed stage I and II hilar CCA in 1993. Since then, patients with unresectable CCA or CCA arising in the setting of PSC have been enrolled in the transplant protocol. Patients with tumors amenable to resection have undergone excision of the extrahepatic duct with lymphadenectomy and liver resection. Methods: We reviewed our experience between January 1993 and August 2004 and compared patient survival between the treatment groups. Results: Seventy-one patients entered the transplant treatment protocol and 38 underwent liver transplantation. Fifty-four patients were explored for resection. Twenty-six (48{\%}) underwent resection, and 28 (52{\%}) had unresectable disease. One-, 3-, and 5-year patient survival were 92{\%}, 82{\%}, and 82{\%} after transplantation and 82{\%}, 48{\%}, and 21{\%} after resection (P = 0.022). There were fewer recurrences in the transplant patients (13{\%} versus 27{\%}). Conclusions: Liver transplantation with neoadjuvant chemoradiation achieved better survival with less recurrence than conventional resection and should be considered as an alternative to resection for patients with localized, node-negative hilar CCA.",
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T1 - Liver transplantation with neoadjuvant chemoradiation is more effective than resection for hilar cholangiocarcinoma

AU - Rea, David J.

AU - Heimbach, Julie K.

AU - Rosen, Charles Burke

AU - Haddock, Michael G.

AU - Alberts, Steven R.

AU - Kremers, Walter K.

AU - Gores, Gregory J.

AU - Nagorney, David M.

AU - Roberts, John P.

AU - Rosen, Charles B.

AU - Jenkins, Roger L.

AU - Shaw Jr, Byers Wendell

AU - Emond, Jean C.

AU - Wall, William J.

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N2 - Objective: Compare survival after neoadjuvant therapy and liver transplantation with survival after resection for patients with hilar CCA. Summary Background Data: We developed a protocol combining neoadjuvant radiotherapy, chemosensitization, and orthotopic liver transplantation for patients with operatively confirmed stage I and II hilar CCA in 1993. Since then, patients with unresectable CCA or CCA arising in the setting of PSC have been enrolled in the transplant protocol. Patients with tumors amenable to resection have undergone excision of the extrahepatic duct with lymphadenectomy and liver resection. Methods: We reviewed our experience between January 1993 and August 2004 and compared patient survival between the treatment groups. Results: Seventy-one patients entered the transplant treatment protocol and 38 underwent liver transplantation. Fifty-four patients were explored for resection. Twenty-six (48%) underwent resection, and 28 (52%) had unresectable disease. One-, 3-, and 5-year patient survival were 92%, 82%, and 82% after transplantation and 82%, 48%, and 21% after resection (P = 0.022). There were fewer recurrences in the transplant patients (13% versus 27%). Conclusions: Liver transplantation with neoadjuvant chemoradiation achieved better survival with less recurrence than conventional resection and should be considered as an alternative to resection for patients with localized, node-negative hilar CCA.

AB - Objective: Compare survival after neoadjuvant therapy and liver transplantation with survival after resection for patients with hilar CCA. Summary Background Data: We developed a protocol combining neoadjuvant radiotherapy, chemosensitization, and orthotopic liver transplantation for patients with operatively confirmed stage I and II hilar CCA in 1993. Since then, patients with unresectable CCA or CCA arising in the setting of PSC have been enrolled in the transplant protocol. Patients with tumors amenable to resection have undergone excision of the extrahepatic duct with lymphadenectomy and liver resection. Methods: We reviewed our experience between January 1993 and August 2004 and compared patient survival between the treatment groups. Results: Seventy-one patients entered the transplant treatment protocol and 38 underwent liver transplantation. Fifty-four patients were explored for resection. Twenty-six (48%) underwent resection, and 28 (52%) had unresectable disease. One-, 3-, and 5-year patient survival were 92%, 82%, and 82% after transplantation and 82%, 48%, and 21% after resection (P = 0.022). There were fewer recurrences in the transplant patients (13% versus 27%). Conclusions: Liver transplantation with neoadjuvant chemoradiation achieved better survival with less recurrence than conventional resection and should be considered as an alternative to resection for patients with localized, node-negative hilar CCA.

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