title: Liver transplantation and combined hepatocellular-cholangiocarcinoma: Feasibility and outcomes.
abstract: BACKGROUND
  Combined hepatocellular-cholangiocarcinoma (CHC or cHCC-CC) is a rare primary liver tumor displaying histological features of both hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA). Most patients are not suitable for surgery because of the advanced stage of the disease at the moment of diagnosis. We decided to review the literature in order to identify the outcomes after liver transplantation for CHC and to clarify which is the most appropriate treatment.
  
  
  METHODS
  A systematic literature search was performed. Studies reporting outcomes of liver transplantation (LT) for CHC and studies comparing oncologic outcomes after LT versus liver resection (LR) for CHC were included in this review.
  
  
  RESULTS
  The mean 5-y Disease Free Survival (DFS) reported in literature is 45.4%, while the mean 5-y overall survival (OS) is 41.8%, analyzing a cohort of 418 cases. The mean DSF in our series after LT was 7.97 months, while the mean OS was 11.7 months.
  
  
  CONCLUSIONS
  LT should be avoided for the treatment of CHC, in order to allocate organs for more appropriate diseases. Moreover, surgical resections, and in particular major hepatectomies, seem to be associated with acceptable outcomes. An accurate preoperative management is needed, and the use of PET-CT when differential diagnosis is difficult should be considered.
authors.affiliation: Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy; Department of General Surgery, Sapienza-University of Rome, Rome, Italy. Electronic address: paolo.magistri@uniroma1.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Magistri
authors.affiliation: Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantino
authors.affiliation: Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Serra
authors.affiliation: Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Cristiano
authors.initials: C
authors.lastname: Guidetti
authors.affiliation: Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Ballarin
authors.affiliation: Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Di Benedetto
mesh_terms: D001650:Bile Duct Neoplasms / Q000601:surgery*; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000601:surgery*; D018572:Disease-Free Survival; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation; D009378:Neoplasms, Multiple Primary / Q000601:surgery*
keywords: CHC; Hepatic stem cells; Liver transplant; Organ allocation; cHCC-CC