For people facing a serious bile duct cancer near the liver, the choice between surgery and transplant can feel overwhelming. This review of past studies compared two paths: a protocol to select patients for liver transplant versus standard liver resection. It found that the transplant approach was linked to higher 5-year survival and better disease-free survival. The analysis looked at 768 patients with this cancer, and it found no significant difference in short-term death rates after surgery. But the story comes with important caveats. The studies were retrospective, meaning they looked back in time, and they had significant selection bias. Also, transplant reports often focus on people who got the transplant, not everyone who was considered, which can make the benefits look bigger than they are. Safety data were not reported in these studies, so we do not know about side effects or complications.
Systematic review and meta-analysis on neoadjuvant selection and liver transplantation for perihilar cholangiocarcinomaTransplant selection may boost survival in bile duct cancer
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Key Takeaway
Consider that liver transplantation may offer higher survival than resection for perihilar cholangiocarcinoma, but interpret findings cautiously due to selection bias.
This is a systematic review and meta-analysis of 768 patients with perihilar cholangiocarcinoma, comparing protocol-based neoadjuvant selection and liver transplantation versus liver resection. The authors synthesized findings on 5-year overall survival, 5-year disease-free survival, 3-year disease-free survival, 3- or 30-day postoperative mortality, and R0 resection rate.
The meta-analysis found that 5-year overall survival was significantly higher with transplantation, as was 5-year disease-free survival. Three-year disease-free survival and the R0 resection rate were also higher with transplantation. There were no significant differences in 3- or 30-day postoperative mortality between the groups.
The authors noted significant selection bias and a retrospective study design as key limitations. They also highlighted that transplant series frequently report post-transplant rather than intention-to-treat outcomes, which may affect the apparent long-term benefit.
Practice relevance was not reported. The findings suggest a potential survival advantage with transplantation but must be interpreted cautiously due to the noted biases and outcome reporting practices.
What this means for you:
For some bile duct cancers, transplant selection may improve survival, but the evidence has real limits. View Original Abstract ↓
BACKGROUND: Perihilar cholangiocarcinoma (CCA) is an aggressive malignancy that presents significant challenges in terms of diagnosis and treatment owing to its anatomical location. Liver resection and transplantation are the primary curative options; however, their long-term outcomes remain controversial. This study aimed to compare the long-term outcomes of protocol-based neoadjuvant selection and liver transplantation with liver resection for the management of perihilar cholangiocarcinoma.
METHODS: A systematic review and meta-analysis were conducted according to the PRISMA guidelines. Electronic databases, including the Cochrane Library, PubMed/MEDLINE, and Embase, were searched for relevant clinical trials comparing liver transplantation with liver resection.
RESULTS: Six studies comprising 768 patients (265 in the liver transplantation group and 503 in the liver resection group) were included. Liver transplantation was associated with significantly higher 5-year overall survival and 5-year disease-free survival. They also showed a higher 3-year disease-free survival rate. Patients in the liver transplantation group had a higher R0 resection rate. There were no significant differences in the 3- or 30-day postoperative mortality between the two groups.
CONCLUSION: Liver transplantation was associated with improved long-term survival in highly selected patients; however, these findings are limited by significant selection bias and the retrospective study design. The apparent long-term benefit observed with LT must be interpreted cautiously because transplant series frequently report post-transplant rather than intention-to-treat outcomes.
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