[Long-term, tumor-free survival after radiotherapy combining hepatectomy-Whipple en bloc and orthotopic liver transplantation for early-stage hilar cholangiocarcinoma].
OBJECTIVE
To report the experience in surveillance and early detection of cholangiocarcinoma (CC) and in using en bloc total hepatectomy-pancreaticoduodenectomy-orthotopic liver transplantation (OLT-Whipple) to achieve complete eradication of early-stage CC complicating primary sclerosing cholangitis (PSC).


METHODS
Asymptomatic PSC patients underwent surveillance using endoscopic ultrasound and endoscopic retrograde cholangiopancreatography (ERCP) with multilevel brushings for cytological evaluation. Patients diagnosed with CC were treated with combined extra-beam radiotherapy, lesion-focused brachytherapy, and OLT-Whipple.


RESULTS
Between January 1988 and February 2001, 42 of 119 PSC patients were followed according to the surveillance protocol. CC was detected in 8 patients, 6 of whom underwent OLT-Whipple. Of those 6 patients, 4 had stage I CC, and 2 had stage II CC. All 6 OLT-Whipple patients received combined external-beam and brachytherapy radiotherapy. The median time from diagnosis to OLT-Whipple was 144 days. One patient died 55 months post-transplant of an unrelated cause, without tumor recurrence. The other 5 were well without recurrence at 79, 82, 108, 128, 129 and 145 months.


CONCLUSIONS
For patients with PSC, ERCP surveillance cytology and intralumenal endoscopic ultrasound examination allow for early detection of CC. Broad and lesion-focused radiotherapy combined with OLT-Whipple to remove the biliary epithelium en bloc offers promising long-term, tumor-free survival. All patients tolerated this extensive surgery well with good quality of life following surgery and recovery. These findings support consideration of the complete excision of an intact biliary tree via OLT-Whipple in patients with early-stage hilar CC complicating PSC.
Wu
You-min
YM
Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA. youminwu@yahoo.com
Johlin
Frederick C
FC
Rayhill
Stephen C
SC
Jensen
Chris S
CS
Jin
Xie
X
Mitros
Frank A
FA
D000293:Adolescent; D000328:Adult; D001650:Bile Duct Neoplasms / Q000175:diagnosis / Q000532:radiotherapy / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000175:diagnosis / Q000532:radiotherapy / Q000601:surgery*; D018572:Disease-Free Survival; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D012189:Retrospective Studies