Liver Transplantation as a New Standard of Care in Patients With Perihilar Cholangiocarcinoma? Results From an International Benchmark Study,Annals of Surgery

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Liver Transplantation as a New Standard of Care in Patients With Perihilar Cholangiocarcinoma? Results From an International Benchmark Study
Annals of Surgery ( IF 7.5 ) Pub Date : 2022-11-01 , DOI: 10.1097/sla.0000000000005641
Eva Breuer ₁ , Matteo Mueller ₁ , Majella B Doyle ₂ , Liu Yang ₃ , Sarwa Darwish Murad ₄ , Imran J Anwar ₅ , Shaheed Merani ₆ , Ashley Limkemann ₇ , Heithem Jeddou ₈ , Steven C Kim ₉ , Victor López-López ₁₀ , Ahmed Nassar ₁₁ , Frederik J H Hoogwater ₁₂ , Eric Vibert ₁₃ , Michelle L De Oliveira ₁ , Daniel Cherqui ₁₃ , Robert J Porte ₁₂ , Joseph F Magliocca ₁₁ , Lutz Fischer ₁₄ , Constantino Fondevila ₁₅ , Krzysztof Zieniewicz ₁₆ , Pablo Ramírez ₁₀ , David P Foley ₉ , Karim Boudjema ₈ , Austin D Schenk ₇ , Alan N Langnas ₆ , Stuart Knechtle ₅ , Wojciech G Polak ₁₇ , C Burcin Taner ₃ , William C Chapman ₂ , Charles B Rosen ₁₈ , Gregory J Gores ₁₉ , Philipp Dutkowski ₁ , Julie K Heimbach ₁₈ , Pierre-Alain Clavien ₁

Affiliation

Department of Surgery and Transplantation, Swiss HPB Center, University Hospital Zurich, Zurich, Switzerland.
Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO.
Department of Transplant, Mayo Clinic Florida, Jacksonville, FL.
Erasmus MC Transplant Institute, University Medical Center Rotterdam, Department of Gastroenterology and Hepatology, Rotterdam, The Netherlands.
Duke Transplant Center, Department of Surgery, Duke University School of Medicine, Durham, NC.
Division of Transplantation and Vascular Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE.
Division of Transplantation Surgery, The Ohio State University Wexner Medical, Columbus, OH.
Department of Hepatobiliary and Digestive Surgery, Pontchaillou University Hospital, Rennes, France.
Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Department of Surgery and Liver and Pancreas Transplantation, Virgen de la Arrixaca Clinic and University Hospital, Murcia, Spain.
Department of Surgery, Emory University, Atlanta, GA.
Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
The Centre Hépato-Biliaire, Paul Brousse Hospital, Villejuif, France.
Department of Hepatobiliary Surgery and Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of General and Digestive Surgery, Hospital Universitario La Paz, Madrid, Spain.
Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
Division of Hepatopancreatobiliary and Transplant Surgery, Erasmus MC Transplant Institute, Department of Surgery, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Division of Transplantation Surgery, Department of Surgery, Mayo Clinic, Rochester, MN.
Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, MN.

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.

中文翻译：

肝移植作为肝门部胆管癌患者的新标准治疗？国际基准研究的结果

客观的：

确定肝门部胆管癌(PHC ) 患者肝移植 (LT) 的基准值，以便进行无偏倚比较。

背景：

许多中心不情愿地使用 PHC 移植，甚至在一些国家禁止使用。虽然 LT 的基准值可用，但缺乏针对 PHC 执行的 LT 的具体数据。

方法：

在最近 5 年期间（2014-2018 年），在 2 个大洲的 17 个参考中心对在类似梅奥方案后考虑进行 LT 的 PHC 患者进行了分析。最短随访时间为 1 年。基准患者被定义为在新辅助放化疗后在高容量中心（≥50 LT/年）进行手术，肿瘤直径 <3 cm，淋巴结阴性，并且没有相关合并症。基准截止值来自所有基准中心的中值的第 75 到第 25 个百分位数。

结果：

一百三十四名连续患者在完成新辅助治疗后接受了 LT。其中，89.6%符合基准案例。基准临界值为 90 天死亡率≤5.2%；1年综合并发症指数≤33.7；≥3级并发症发生率≤66.7%。这些值优于其他 LT 适应症的基准值。与接受根治性肝切除术的匹配的淋巴结阴性患者组 (n=106) 相比，五年无病生存率明显更高（62% 对 32%，P <0.001）。