title: Comparison between resection and transplantation in combined hepatocellular and cholangiocarcinoma.
abstract: OBJECTIVE
  The treatment of choice for combined hepatocellular and cholangiocarcinoma (cHCC-CC) is surgical resection. However, the efficacy of liver transplantation is not clear. We compared the surgical outcome of hepatic resection and liver transplantation for cHCC-CC.
  
  
  METHODS
  From 1995 to 2012, 89 patients were diagnosed with cHCC-CC after hepatic resection and 8 patients diagnosed with cHCC-CC after liver transplantation. We excluded 21 patients who were American Joint Committee on Cancer Staging Stage III or IV and lost to follow-up. The outcomes were reviewed retrospectively.
  
  
  RESULTS
  The poor prognostic factors in cHCC-CC patients who underwent hepatectomy were large tumor size (>5 cm), small safety margin (<2 cm), and low preoperative albumin level. The disease-free survival (DFS) and overall survival (OS) between the hepatectomy group (n = 68) and the liver transplant group (n = 8) was not statistically different (5-year DFS: 26.2% vs 37.5%, P = .333; 5-year OS: 42.1% vs 50%, P = .591). In the small tumor subgroup (tumor size <5 cm), the DFS and OS between the 2 surgical procedures was not different, and in the adequate resection margin subgroup (safety margin >2 cm), survival was comparable.
  
  
  CONCLUSIONS
  In well-selected cases with small tumor size and with preserved liver function, liver resection should be considered when complete resection is possible.
authors.affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: S
authors.initials: S
authors.lastname: Song
authors.forename: H H
authors.initials: HH
authors.lastname: Moon
authors.forename: S
authors.initials: S
authors.lastname: Lee
authors.forename: T-S
authors.initials: TS
authors.lastname: Kim
authors.forename: M
authors.initials: M
authors.lastname: Shin
authors.forename: J M
authors.initials: JM
authors.lastname: Kim
authors.forename: J B
authors.initials: JB
authors.lastname: Park
authors.forename: C H D
authors.initials: CH
authors.lastname: Kwon
authors.forename: S J
authors.initials: SJ
authors.lastname: Kim
authors.forename: S-K
authors.initials: SK
authors.lastname: Lee
authors.forename: J-W
authors.initials: JW
authors.lastname: Joh
mesh_terms: D001650:Bile Duct Neoplasms / Q000601:surgery*; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000601:surgery*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis