Case report
Liver
Neoadjuvant Therapy Protocol and Liver Transplantation in Combination With Pancreatoduodenectomy for the Treatment of Hilar Cholangiocarcinoma Occurring in a Case of Primary Sclerosing Cholangitis: Case Report With a More Than 8-Year Disease-Free Survival

https://doi.org/10.1016/j.transproceed.2011.01.140Get rights and content

Abstract

Cholangiocarcinoma has historically represented a major contraindication to liver transplantation at many centers because of its high recurrence rate and low disease-free survival rate, even after radical surgery. Novel neoadjuvant therapy protocols combined with demolitive surgery and liver transplantation seem to achieve successful results in terms of overall and disease-free survivals. Surgery frequently seems to be unsatisfactory only for patients also suffering from chronic cirrhosis or end-stage liver disease. We have reported a case of hilar cholangiocarcinoma occurring in a case of primary sclerosing cholangitis treated with neoadjuvant radiochemotherapy and endoscopic brachytherapy, followed by liver transplantation combined with pancreatoduodenectomy, who has survived free of disease for >8 years.

Section snippets

Case Report

A 55-year-old woman with PSC-related cirrhosis underwent Magnetic resonance imaging (MRI) as part of her routine follow-up, which revealed a 20-mm hilar mass with intrahepatic biliary dilation but no gross vascular invasion. CA 19-9 was 1499 KU/L and a needle biopsy confirmed a well-differentiated CC with necrotic areas. In December 2001, she was treated according to protocol with external beam radiation and neoadjuvant chemotherapy with intravenous 5-fluoracil (5-FU). In January 2002, she was

Discussion

CC accounts for 3% of all gastrointestinal cancers1 and it is more common in patients with PSC, whose risk of developing this cancer is 8%–12%.2 Bile duct bifurcation (Klatskin tumors)1 is involved in 60%–70% of cases of CC, which arise in a critical anatomic position, often making their operative resection a challenge. Reports in the literature show that liver resection achieves 5-year survival rates of 20%–43%,3, 6 but this approach is unfortunately only feasible in a minority of cases.

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