Liver transplantation increases R0 resection and survival of patients with a non-disseminated unresectable Klatskin tumour

Abstract

Introduction

There are no established indications for liver transplant (LT) in patients with a Klatskin tumour (KT) due to the differences in the published results. Objective To report on our patients who have non-disseminated unresectable KT and who were given a LT, and to compare results with those of patients who have had tumour resection and those who have not.

Patients and method

We have treated 75 patients diagnosed with KT. The mean age was 62 (11) years (range, 38–88 years) and 50 were males (66%). Twenty patients were inoperable. Of the 55 patients who underwent surgery: tumour resection (TR) was performed in 29 cases; there was no tumour dissemination in 11 unresectable cases and therefore these patients were added to the LT waiting list and the remaining 15 unresectable cases had tumour dissemination and remained on palliative treatment.

Results

In the LT group there was no postoperative mortality (during the first month) and the survival rate was 95%, 59%, and 36% with a disease-free survival of 75%, 40%, and 20%; whereas the patients given RT had a survival rate of 80%, 52%, and 38% at 1, 3, and 5 years, with a disease-free survival of 65%, 35%, and 19%, without any differences compared to the LT group. Patients with unresectable tumour left on palliative therapy had a lower survival than the unresectable who underwent LT (P < 001).

Conclusions

In patients with non-disseminated unresectable KT, LT has a similar survival to that obtained in cases with resectable R0 liver resection. LT improves the survival rate achieved using palliative treatment in patients with non-disseminated unresectable KT.

Resumen

Introducción

La indicación de trasplante hepático (TH) en el tumor de Klatskin (TK) no está establecida debido a la discrepancia en los resultados de las series publicadas.

Objetivo

Presentar los resultados del TH en pacientes con TK irresecable no diseminado y compararlos con los obtenidos en los pacientes no resecados y con resección del tumor.

Pacientes y método

Hemos tratado 75 pacientes con TK. La edad media fue de 62 ± 11 años (rango: 38–88) y 50 fueron varones (66%). Veinte pacientes se consideraron inoperables. Se realizó resección del tumor (RT) en 29 de los 55 pacientes operados, TH en 11 casos (en tumores irresecables no diseminados) y tratamiento paliativo en los 15 pacientes con TK irresecables diseminados.

Resultados

En el grupo TH no hubo mortalidad postoperatoria (primer mes) y presentaron una supervivencia a 1, 3 y 5 años del 95, el 59 y el 36% con una supervivencia libre de enfermedad (SLE) del 75, el 40 y el 20%. Los pacientes con RT presentaron una supervivencia del 80, el 52 y el 38%, con una SLE del 65, el 35 y el 19%, sin diferencias respecto al grupo TH. Los pacientes con tumor irresecable que quedaron con tratamientos paliativos presentaron una supervivencia inferior a la de los pacientes con tumores irresecables que recibieron TH (p < 0,001).

Conclusiones

En pacientes con TK irresecable no diseminado, el TH consigue una supervivencia similar a la obtenida en los casos resecables con la resección hepática R0, y mejora claramente la esperanza de vida de estos pacientes con tratamientos paliativos.