Rea DJ et al. (2005) Liver transplantation with neoadjuvant chemoradiation is more effective than resection for hilar cholangiocarcinoma. Ann Surg 242: 451–461

Therapy for hilar cholangiocarcinoma (CCA) remains a challenge. Curative resection is often not an option owing to vascular encasement, hilar invasion, bilateral liver involvement and primary sclerosing cholangitis; however, to date, liver transplantation has achieved limited long-term survival in the majority of patients. Rea and colleagues have designed a protocol of neoadjuvant chemoradiotherapy and orthotopic liver transplantation for patients with unresectable hilar CCA, and compared survival and recurrence rates with patients treated with conventional resection.

Between January 1993 and August 2004, 38 patients received a liver transplant and 54 underwent resection; 26 of these surgeries were intended to be curative. For the liver transplant recipients, survival at 1, 3 and 5 years following the procedure was 92%, 82% and 82% respectively. In the 26 patients receiving potentially curative resection, survival was significantly lower: 82%, 48% and 21% at the 1, 3 and 5-year follow-up points. The incidence of tumor recurrence was also higher in the resection patients than the transplant recipients, and recurrence appeared sooner.

The authors conclude, despite the difficulty in comparing the two groups, that their liver transplantation protocol achieves higher survival with less recurrence than potentially curative resection in patients with node-negative, localized hilar CCA, and should be considered as an alternative treatment option in such patients.