Conversion surgery after radical chemotherapy using living donor liver transplantation for locally advanced unresectable perihilar cholangiocarcinoma without neoadjuvant radiation
Shigehito Miyagi1, Atsushi Fujio1, Kei Nakagawa1, Kazuaki Tokodai1, Toshiaki Kashiwadate1, Koji Miyazawa1, Kengo Sasaki1, Yuki Miyazaki1, Muneyuki Matsumura1, Takashi Kamei1, Michiaki Unno1.
1Department of Surgery, Tohoku University, Sendai, Japan
Introduction: Because of including crucial blood vessels in portal area, perihilar cholangiocarcinoma (pCCA) is sometimes unresectable. Recently, there have been several reports about those cases prognosis of improving drastically with transplantation and combined chemoradiation therapy. However, liver transplantation for pCCA has some problems. The first is that pCCA is located at a lethal position and its progress is sometimes rapid; therefore, the optimal timing of transplantation is lost. The second is vascular complications associated with neoadjuvant radiation. To overcome these problems, we performed conversion surgery using LDLT with simultaneous resection of the hepatic artery and portal vein, instead of neoadjuvant radiation. Herein, we report our experience of interposition reconstruction.
Methods: The patient is a 31-year-old man with primary sclerosing cholangitis (PSC). He was diagnosed with locally advanced pCCA. His pCCA was unresectable (Bismuth type IV). The patient underwent radical chemotherapy (gemcitabine/cisplatin/S-1) and avoided radiation. After 6 months, his pCCA were well-controlled, except for the local area. However, there was no time to wait brain death donor. Then, we immediately performed LDLT with simultaneous resection of hepatic artery and portal vein, and interposition reconstruction using auto-vessel grafts.
Results: The recipient recovered and was discharged 31 days post-transplantation. His liver function improved, and he has no recurrence after LDLT for 6months.
Conclusion: LDLT with neoadjuvant radiation is associated with high risk of vascular complications. In some cases, conversion surgery after radical chemotherapy using good timing LDLT without radiation may increase chances of transplantation for locally advanced pCCA.
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