Cleveland Clinic’s Liver Tumor Clinic is now offering liver transplantation to treat hilar cholangiocarcinoma, a highly aggressive cancer with few potentially curative treatment options. Cleveland Clinic joins a select group of centers worldwide that offers transplantation for this cancer.
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Hilar cholangiocarcinoma, a cancer of the bile duct at the level of bifurcation of the hepatic ducts, is among the most malignant cancers, according to Federico Aucejo, MD, a hepatobiliary and transplant surgeon with the Liver Tumor Clinic. Although several therapies are available for palliation, the only hope for a cure is with either partial liver resection or transplantation.
Only about 10 to 30 percent of patients present with early-stage disease that is amenable to curative partial resection. In addition, many patients with hilar cholangiocarcinoma have underlying primary sclerosing cholangitis and poor liver function and are unable to tolerate losing part of the organ by resection.
“Resection and transplantation are the only options that offer a cure for this aggressive cancer,” says Dr. Aucejo. “Being able to perform transplantation at Cleveland Clinic opens up an important new option for our patients.”
Careful Patient Selection Is Key
K.V. Narayanan Menon, MD, Medical Director of Liver Transplantation at Cleveland Clinic, emphasizes that many selection criteria must be met before a patient with hilar cholangiocarcinoma can be deemed a candidate for liver transplantation.
“Diagnosing the cancer at an early stage of disease is critical,” says Dr. Menon. He adds that newer modalities, such as fluorescent in situ hybridization (FISH), yield earlier results and are thus preferable to older techniques such as brush cytology.
Once diagnosed, the patient must first undergo neoadjuvant chemoradiation therapy to reduce the tumor as much as possible. Surgical exploration is performed to ensure that cancer has not spread to other parts of the liver or beyond. Only then can the patient be deemed ready for listing for obtaining an organ. The average wait for a cadaveric liver transplant in patients with liver cancer is four to six months, roughly half the time at other major liver transplant centers in the United States. Living donor liver transplantation is another option for these patients and entails a significantly shorter wait time.
“The survival rate for liver transplantation for hilar cholangiocarcinoma in patients meeting the strict criteria is in the order of 70 to 80 percent at five years and justifies the use of scarce organs for this purpose,” says Dr. Aucejo. “This rate is comparable to success rates for other diseases for which liver transplantation is used.”
Liver transplantation has been found in some studies to be superior to resection, which is more prone to the development of cancer recurrence over time.
Multidisciplinary Teamwork Essential to Success
The Liver Tumor Clinic provides comprehensive and customized services, with the ability to schedule multiple appropriate consultations in one place and on the same day. Successful cancer therapy involves the contributions of oncologists, hepatologists, surgeons, radiologists, pathologists and nurse practitioners and coordinators to determine the best course at every stage of treatment.
“Taking a multidisciplinary collaborative approach has been critical to the success of our liver transplant program,” says Dr. Aucejo. “The Liver Tumor Clinic is invaluable in bringing the whole healthcare team together to treat complex cases in a seamless manner.”