title: Liver transplantation with neoadjuvant chemoradiation is more effective than resection for hilar cholangiocarcinoma.
abstract: OBJECTIVE
  Compare survival after neoadjuvant therapy and liver transplantation with survival after resection for patients with hilar CCA.
  
  
  BACKGROUND
  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.
authors.affiliation: Division of Gstroenterologic & General Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Rea
authors.forename: Julie K
authors.initials: JK
authors.lastname: Heimbach
authors.forename: Charles B
authors.initials: CB
authors.lastname: Rosen
authors.forename: Michael G
authors.initials: MG
authors.lastname: Haddock
authors.forename: Steven R
authors.initials: SR
authors.lastname: Alberts
authors.forename: Walter K
authors.initials: WK
authors.lastname: Kremers
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Gores
authors.forename: David M
authors.initials: DM
authors.lastname: Nagorney
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001650:Bile Duct Neoplasms / Q000601:surgery* / Q000628:therapy; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000601:surgery* / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D006498:Hepatectomy; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents