Strategic International Session3(JSGS・JSGE・JSH)
Sat. November 4th   9:00 - 11:30   Room 9: Portopia Hotel Main Building Kairaku 3
Experience with living donor liver transplantation for hilar and intrahepatic cholangiocarcinoma
Takashi Ito1, Takamichi Ishii1, Etsuro Hatano1
1Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University
Liver transplantation for biliary malignancies in Japan is delayed compared to Western countries. Still, some patients are potential candidates for LT even in Japan, that is, the patients with insufficient liver remnant, the patients with extensive locally advanced disease, which makes vascular reconstruction impossible, the patients with extensive longitudinal extension, and the patients with PSC, which makes it difficult to determine the area of cancer spread.
We launched LDLT program for unresectable phCCA in 2018. The main inclusion criteria are unresectable phCCA because of one of the 4 reasons, and the exclusion criteria was those with distant or lymph node metastasis. We perform both chemotherapy and radiation therapy as neoadjuvant treatment. We do staging laparoscopy and laparotomy for lymph nodes sampling to rule out LN metastasis a few weeks before LDLT.
Liver transplantation for intrahepatic cholangiocarcinoma iCCA is more controversial even in Western countries. For advanced cases, LT after disease control period with chemotherapy at least 6 months was proposed.
So far eleven patients with perihilar CCA have been considered for LT, and three patients with phCCA and one patient with iCCA underwent LDLT until now. All four patients are alive after liver transplantation.
In conclusion, LDLT for phCCA and iCCA is feasible and can be the last bastion for unresectable CCAs. Long-term outcomes should be carefully monitored.
Index Term 1: Cholangiocarcinoma
Index Term 2: Liver transplantation
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