Long-term, tumor-free survival after radiotherapy combining hepatectomy-Whipple en bloc and orthotopic liver transplantation for early-stage hilar cholangiocarcinoma

You-min Wu; Frederick C Johlin; Stephen C Rayhill; Chris S Jensen; Xie Jin; Frank A Mitros

doi:10.3760/cma.j.issn.0529-5815.2009.15.012

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Journal article

Long-term, tumor-free survival after radiotherapy combining hepatectomy-Whipple en bloc and orthotopic liver transplantation for early-stage hilar cholangiocarcinoma

You-min Wu, Frederick C Johlin, Stephen C Rayhill, Chris S Jensen, Xie Jin and Frank A Mitros

Chung-hua wai kʿo tsa chih, Vol.47(15), pp.1155-1161

08/01/2009

DOI: 10.3760/cma.j.issn.0529-5815.2009.15.012

PMID: 20021907

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Abstract

To report the experience in surveillance and early detection of cholangiocarcinoma (CC) and in using en bloc total hepatectomy-pancreaticoduodenectomy-orthotopic liver transplantation (OLT-Whipple) to achieve complete eradication of early-stage CC complicating primary sclerosing cholangitis (PSC). Asymptomatic PSC patients underwent surveillance using endoscopic ultrasound and endoscopic retrograde cholangiopancreatography (ERCP) with multilevel brushings for cytological evaluation. Patients diagnosed with CC were treated with combined extra-beam radiotherapy, lesion-focused brachytherapy, and OLT-Whipple. Between January 1988 and February 2001, 42 of 119 PSC patients were followed according to the surveillance protocol. CC was detected in 8 patients, 6 of whom underwent OLT-Whipple. Of those 6 patients, 4 had stage I CC, and 2 had stage II CC. All 6 OLT-Whipple patients received combined external-beam and brachytherapy radiotherapy. The median time from diagnosis to OLT-Whipple was 144 days. One patient died 55 months post-transplant of an unrelated cause, without tumor recurrence. The other 5 were well without recurrence at 79, 82, 108, 128, 129 and 145 months. For patients with PSC, ERCP surveillance cytology and intralumenal endoscopic ultrasound examination allow for early detection of CC. Broad and lesion-focused radiotherapy combined with OLT-Whipple to remove the biliary epithelium en bloc offers promising long-term, tumor-free survival. All patients tolerated this extensive surgery well with good quality of life following surgery and recovery. These findings support consideration of the complete excision of an intact biliary tree via OLT-Whipple in patients with early-stage hilar CC complicating PSC.

Bile Duct Neoplasms - surgery

Liver Transplantation

Cholangiocarcinoma - diagnosis

Follow-Up Studies

Humans

Middle Aged

Male

Pancreaticoduodenectomy

Bile Duct Neoplasms - radiotherapy

Hepatectomy

Bile Duct Neoplasms - diagnosis

Disease-Free Survival

Cholangiocarcinoma - surgery

Mass Screening

Adolescent

Adult

Bile Ducts, Intrahepatic

Female

Retrospective Studies

Cholangiocarcinoma - radiotherapy

Early Diagnosis

Details

Title: Subtitle: Long-term, tumor-free survival after radiotherapy combining hepatectomy-Whipple en bloc and orthotopic liver transplantation for early-stage hilar cholangiocarcinoma
Creators: You-min Wu - Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA. youminwu@yahoo.com
Frederick C Johlin
Stephen C Rayhill
Chris S Jensen
Xie Jin
Frank A Mitros
Resource Type: Journal article
Publication Details: Chung-hua wai kʿo tsa chih, Vol.47(15), pp.1155-1161
DOI: 10.3760/cma.j.issn.0529-5815.2009.15.012
PMID: 20021907
ISSN: 0529-5815
Language: Chinese
Date published: 08/01/2009
Academic Unit: Gastroenterology and Hepatology; Pathology; Internal Medicine
Record Identifier: 9984094877202771

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