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Comparison between liver transplantation and resection for hilar cholangiocarcinoma: A systematic review and meta-analysis.

Publication ,  Journal Article
Moris, D; Kostakis, ID; Machairas, N; Prodromidou, A; Tsilimigras, DI; Ravindra, KV; Sudan, DL; Knechtle, SJ; Barbas, AS
Published in: PLoS One
2019

BACKGROUND: Hilar cholangiocarcinoma (hCCA) is a rare and aggressive malignancy with R0 resection being currently the only option for long-term survival. With the improvement in the outcomes of liver transplantation (LT), the indications for LT have expanded to include other malignant tumors, such as hCCA. The aim of the present analysis is to demonstrate and critically evaluate the outcomes of LT compared to resection with curative intent in patients with hCCA. METHODS: We systematically searched the literature for articles published up to May 2018. The following algorithm was applied ((hilar cholangiocarcinoma) OR (perihilar cholangiocarcinoma) OR klatskin$ OR (bile duct neoplasm) OR cholangiocarcinoma) AND (transplant$ OR graft$). RESULTS: Neoadjuvant treatment with chemotherapy and radiation therapy was far more common in the LT group, with very few patients having received preoperative therapy in the resection group (p = 0.0005). Moreover, length of hospital stay was shorter after LT than after resection (p<0.00001). In contrast, no difference was found between the two treatment methods concerning postoperative mortality (p = 0.57). There was a trend towards longer overall survival after LT in comparison with resection. This was not obvious in the first year postoperatively, however, the advantage of LT over resection became obvious at 3 years after the operation (p = 0.02). CONCLUSIONS: In non-disseminated unresectable tumors, LT seems to have a non-inferior survival. In the same patients, neoadjuvant chemoradiotherapy and/or strict selection criteria may contribute to superior survival outcomes compared to curative-intent resection. Due to the scarcity of level 1 evidence, it remains unclear whether LT should be increasingly considered for technically resectable early stage hCCA.

Duke Scholars

Published In

PLoS One

DOI

EISSN

1932-6203

Publication Date

2019

Volume

14

Issue

7

Start / End Page

e0220527

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Survival Rate
  • Liver Transplantation
  • Klatskin Tumor
  • Humans
  • Hepatectomy
  • General Science & Technology
  • Bile Duct Neoplasms
 

Citation

APA
Chicago
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MLA
NLM
Moris, D., Kostakis, I. D., Machairas, N., Prodromidou, A., Tsilimigras, D. I., Ravindra, K. V., … Barbas, A. S. (2019). Comparison between liver transplantation and resection for hilar cholangiocarcinoma: A systematic review and meta-analysis. PLoS One, 14(7), e0220527. https://doi.org/10.1371/journal.pone.0220527
Moris, Dimitrios, Ioannis D. Kostakis, Nikolaos Machairas, Anastasia Prodromidou, Diamantis I. Tsilimigras, Kadiyala V. Ravindra, Debra L. Sudan, Stuart J. Knechtle, and Andrew S. Barbas. “Comparison between liver transplantation and resection for hilar cholangiocarcinoma: A systematic review and meta-analysis.PLoS One 14, no. 7 (2019): e0220527. https://doi.org/10.1371/journal.pone.0220527.
Moris D, Kostakis ID, Machairas N, Prodromidou A, Tsilimigras DI, Ravindra KV, et al. Comparison between liver transplantation and resection for hilar cholangiocarcinoma: A systematic review and meta-analysis. PLoS One. 2019;14(7):e0220527.
Moris, Dimitrios, et al. “Comparison between liver transplantation and resection for hilar cholangiocarcinoma: A systematic review and meta-analysis.PLoS One, vol. 14, no. 7, 2019, p. e0220527. Pubmed, doi:10.1371/journal.pone.0220527.
Moris D, Kostakis ID, Machairas N, Prodromidou A, Tsilimigras DI, Ravindra KV, Sudan DL, Knechtle SJ, Barbas AS. Comparison between liver transplantation and resection for hilar cholangiocarcinoma: A systematic review and meta-analysis. PLoS One. 2019;14(7):e0220527.

Published In

PLoS One

DOI

EISSN

1932-6203

Publication Date

2019

Volume

14

Issue

7

Start / End Page

e0220527

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Survival Rate
  • Liver Transplantation
  • Klatskin Tumor
  • Humans
  • Hepatectomy
  • General Science & Technology
  • Bile Duct Neoplasms