Department of Surgery, Tohoku University Graduate School of Medicine, Seiryo, Sendai, Japan.
Department of Surgery, Tohoku University Graduate School of Medicine, Seiryo, Sendai, Japan.
Transplant Proc. 2022 Jul-Aug;54(6):1643-1647. doi: 10.1016/j.transproceed.2022.03.054. Epub 2022 Jul 7.
Perihilar cholangiocarcinoma (pCCA) is often unresectable, because it includes crucial blood vessels in portal area. The prognosis of locally advanced unresectable cholangiocarcinomas is extremely poor. Recently, there have been several reports of the prognosis improving drastically with transplantation and combined chemoradiation therapy. However, liver transplantation for pCCA has 2 big problems. The first is that pCCA is located at a lethal position and its progress is sometimes rapid; therefore, the optimal timing of transplantation is sometimes lost. The second is vascular complications associated with neoadjuvant radiation, especially in living donor liver transplantation (LDLT). To overcome these problems, we performed conversion surgery using LDLT with simultaneous resection of the hepatic artery and portal vein, instead of neoadjuvant radiation. Herein, we report our experience of interposition reconstruction.
A 31-year-old man with primary sclerosing cholangitis (PSC) was diagnosed with locally advanced unresectable pCCA. The patient underwent radical chemotherapy (gemcitabine/cisplatin/S-1) and avoided radiation because of PSC. After 6 months, positron emission tomography-computed tomography revealed no lymph node metastasis. There was no time to wait. We immediately performed LDLT with simultaneous resection of hepatic artery and portal vein, and microsurgical reconstruction using auto-vessel grafts.
The recipient recovered and was discharged 31 days posttransplant. His liver function improved, and he has had no recurrence after LDLT.
LDLT with neoadjuvant radiation is associated with high risk of vascular complications. In some cases, conversion surgery after radical chemotherapy using good timing LDLT without radiation may increase chances of transplantation for locally advanced pCCA.
肝门部胆管癌（pCCA）常无法切除，因为它包含门静脉区域的重要血管。局部晚期不可切除的胆管癌预后极差。最近，有几篇报道称，通过移植和联合放化疗，预后明显改善。然而，pCCA 的肝移植有两个大问题。一是 pCCA 位置致命，进展有时迅速，因此移植的最佳时机有时会丧失。二是新辅助放疗相关的血管并发症，尤其是在活体肝移植（LDLT）中。为克服这些问题，我们采用 LDLT 联合肝动脉和门静脉切除进行转化手术，而不是新辅助放疗。在此，我们报告我们使用 LDLT 进行间置重建的经验。
一名 31 岁原发性硬化性胆管炎（PSC）患者被诊断为局部晚期不可切除的 pCCA。患者接受了根治性化疗（吉西他滨/顺铂/S-1），由于 PSC 避免了放疗。6 个月后，正电子发射断层扫描-计算机断层扫描（PET-CT）显示无淋巴结转移。没有时间等待。我们立即进行 LDLT 联合肝动脉和门静脉切除，并使用自体血管移植物进行显微外科重建。
受者恢复并在移植后 31 天出院。他的肝功能改善，在 LDLT 后无复发。
新辅助放疗的 LDLT 伴有高血管并发症风险。在某些情况下，在不进行放疗的情况下，使用时机良好的 LDLT 进行根治性化疗后进行转化手术，可能会增加局部晚期 pCCA 移植的机会。
