Andraus Wellington, Ochoa Gabriela, de Martino Rodrigo Bronze, Pinheiro Rafael Soares Nunes, Santos Vinicius Rocha, Lopes Liliana Ducatti, Arantes Júnior Rubens Macedo, Waisberg Daniel Reis, Santana Alexandre Chagas, Tustumi Francisco, D'Albuquerque Luiz Augusto Carneiro
Department of Gastroenterology, Transplantation Unit, Universidade de São Paulo, São Paulo, Brazil.
Front Oncol. 2024 May 21;14:1404683. doi: 10.3389/fonc.2024.1404683. eCollection 2024.
Intrahepatic cholangiocarcinoma (iCC) is the liver's second most common neoplasm. Until now, surgery is the only curative option, but only 35% of the cases are considered resectable at the diagnosis, with a post-resection survival of around 30%. Advancements in surgical techniques and perioperative care related to liver transplantation (LT) have facilitated the expansion of indications for hepatic neoplasms.
This study is a comprehensive review of the global experience in living donor LT (LDLT) for treating iCC and describes our first case of LDLT for an unresectable iCC.
While exploring LT for intrahepatic cholangiocarcinoma dates to the 1990s, the initial outcomes were discouraging, marked by poor survival and high recurrence rates. Nevertheless, contemporary perspectives underscore a reinvigorated emphasis on extending the frontiers of LT indications within the context of the "oncologic era." The insights gleaned from examining explants, wherein incidental iCC was categorized as hepatocellular carcinoma in the preoperative period, have demonstrated comparable survival rates to small hepatocellular carcinoma. These findings substantiate the potential viability of LT as a curative alternative for iCC. Another investigated scenario pertains to "unresectable tumors with favorable biological behavior," LT presents a theoretical advantage by providing free margins without the concern of a small future liver remnant. The constraint of organ shortage persists, particularly in nations with low donation rates. LDLT emerges as a viable and secure alternative for treating iCC.
LDLT is an excellent option for augmenting the graft pool, particularly in carefully selected patients.
肝内胆管癌（iCC）是肝脏第二常见的肿瘤。到目前为止，手术是唯一的治愈选择，但在诊断时只有35%的病例被认为可切除，切除术后生存率约为30%。与肝移植（LT）相关的手术技术和围手术期护理的进步促进了肝脏肿瘤适应证的扩大。
本研究全面回顾了活体供体肝移植（LDLT）治疗iCC的全球经验，并描述了我们首例LDLT治疗不可切除iCC的病例。
虽然探索肝移植治疗肝内胆管癌可追溯到20世纪90年代，但最初的结果令人沮丧，生存率低且复发率高。然而，当代观点强调在“肿瘤学时代”的背景下重新强调扩大肝移植适应证的范围。通过检查外植体获得的见解表明，术前偶然发现的iCC被归类为肝细胞癌，其生存率与小肝细胞癌相当。这些发现证实了肝移植作为iCC治愈性替代方案的潜在可行性。另一个研究的情况涉及“具有良好生物学行为的不可切除肿瘤”，肝移植通过提供切缘阴性且无需担心未来肝残余过小而具有理论优势。器官短缺的限制仍然存在，特别是在捐赠率低的国家。活体供体肝移植成为治疗iCC的可行且安全的替代方案。
活体供体肝移植是增加供肝来源的极佳选择，特别是在经过精心挑选的患者中。
