Five Year Overall Survival Following Mayo Protocol for Hilar Cholangiocarcinoma Justifies its Continued Use; the Dublin Experience

Abstract

Background: The Mayo Clinic has reported a 5-year survival above 70% following neoadjuvant chemoradiation and liver transplantation for unresectable hilar cholangiocarcinoma (hCCA) . Despite these good results it has not been widely accepted, mainly in Europe. Methods: All the patients affected by hCCA who underwent neoadjuvant treatment and liver transplantation from October 2004 to December 2016 were included in the study. Data were collected regarding patients characteristics, treatment related complications, recurrence and survival. Results: 26 patients with histologically proven, unresectable, hCCA (92% male, mean age 48 years) were included in the study, 24 patients (92%) had a hCCA on PSC. 6 patients (23%) required a Whipple at the time of the transplant and 4 (17%) required a redo transplant. All but 1 patient had a R0 resection, 9 patients (34.6%) had a residual tumor in the explanted liver. Surgical mortality and morbidity were 17% and 38%, respectively. The 3-year overall survival was 63.2% and the 5-year overall survival 51.6%. At the univariate analysis the presence of residual tumor in the explanted liver (p=0.011, OR=25) was the only identified risk factors for disease recurrence. Conclusion: Long term survival can be achieved in patients with unresectable hCCA using neoadjuvant chemoradiotherapy and liver transplantation with acceptable surgical mortality and morbidity. The presence of residual tumor in the explanted liver is a risk factor for disease recurrence.