Patrono Damiano, Colli Fabio, Colangelo Matteo, De Stefano Nicola, Apostu Ana Lavinia, Mazza Elena, Catalano Silvia, Rizza Giorgia, Mirabella Stefano, Romagnoli Renato
General Surgery 2U-Liver Transplant Unit, Department of Surgical Sciences, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Università di Torino, Corso Bramante 88-90, 10126 Turin, Italy.
J Clin Med. 2023 Mar 3;12(5):2026. doi: 10.3390/jcm12052026.
Perihilar cholangiocarcinomas (pCCA) are rare yet aggressive tumors originating from the bile ducts. While surgery remains the mainstay of treatment, only a minority of patients are amenable to curative resection, and the prognosis of unresectable patients is dismal. The introduction of liver transplantation (LT) after neoadjuvant chemoradiation for unresectable pCCA in 1993 represented a major breakthrough, and it has been associated with 5-year survival rates consistently >50%. Despite these encouraging results, pCCA has remained a niche indication for LT, which is most likely due to the need for stringent candidate selection and the challenges in preoperative and surgical management. Machine perfusion (MP) has recently been reintroduced as an alternative to static cold storage to improve liver preservation from extended criteria donors. Aside from being associated with superior graft preservation, MP technology allows for the safe extension of preservation time and the testing of liver viability prior to implantation, which are characteristics that may be especially useful in the setting of LT for pCCA. This review summarizes current surgical strategies for pCCA treatment, with a focus on unmet needs that have contributed to the limited spread of LT for pCCA and how MP could be used in this setting, with a particular emphasis on the possibility of expanding the donor pool and improving transplant logistics.
肝门部胆管癌（pCCA）是一种起源于胆管的罕见但侵袭性强的肿瘤。虽然手术仍然是主要的治疗方法，但只有少数患者适合进行根治性切除，不可切除患者的预后很差。1993年，对于不可切除的pCCA患者，在新辅助放化疗后引入肝移植（LT）是一个重大突破，其5年生存率一直>50%。尽管取得了这些令人鼓舞的结果，但pCCA仍然是LT的一个小众适应症，这很可能是由于需要严格筛选候选者以及术前和手术管理方面的挑战。最近，机器灌注（MP）作为静态冷藏的替代方法被重新引入，以改善对边缘供肝的肝脏保存。除了与更好的移植物保存相关外，MP技术还允许安全延长保存时间并在植入前测试肝脏活力，这些特性在pCCA的LT治疗中可能特别有用。本综述总结了目前pCCA治疗的手术策略，重点关注导致pCCA的LT应用受限的未满足需求，以及MP在这种情况下的应用方式，特别强调扩大供体库和改善移植后勤保障的可能性。
