日本消化器病学会 アーカイブシステム

セッション情報 JDDW International Debate Session（Featured Lecture）3(JDDW)

JDDW International Debate Session　「Treatment of CCC (To transplant vs Not to transplant)」
タイトル IS1-3-1：

Surgical Treatment of Hilar Cholangiocarcinoma: The Rationale to Transplant
演者 C. B.　Rosen（Mayo Clinic）
共同演者
抄録 Background: Neoadjuvant chemoradiotherapy followed by operative staging and liver transplantation is an effective treatment for patients with unresectable hilar cholangiocarcinoma (CCA) and CCA arising in the setting of primary sclerosing cholangitis (PSC).
Aim: To determine the best treatment for patients with hilar cholangiocarcinoma.
Method: Comparison of results reported with transplantation versus those with resection.
Results: Mayo Clinic Rochester treated 237 patients with neoadjuvant therapy with the intention to proceed with transplantation between 1993 and 2013. All patients had CCA arising in the setting of PSC or unresectable CCA arising de novo. Patient survival 5 years after start of therapy was 64 ± 4% for 141 patients with CCA arising in PSC and 39 ± 6% for 96 patients with CCA arising de novo. 153 patients underwent transplantation, and 5-year survival after transplantation was 81 ± 4% for 96 patients with CCA arising in PSC and 58 ± 7% for 57 patients with CCA arising de novo. These results have been corroborated by a multicenter study in the US. Results for patients with CCA arising in PSC are clearly superior to all other modes of therapy. Resection is most often precluded by the underlying liver disease. Results for patients with CCA arising de novo are comparable to results achieved with resection, but the patients had unresectable disease.
Conclusion: CCA arising in the setting of PSC is best treated by neoadjuvant therapy and liver transplantation. Results with neoadjuvant therapy and liver transplantation are comparable to results achieved with resection, even for patients with unresectable disease. It is reasonable to speculate that results with neoadjuvant therapy and transplantation would be even better for patients with resectable CCA, but it is controversial to consider whether the difference would be large enough to justify use of a scare deceased donor liver or a liver from a living donor.
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