Orthotopic liver transplantation for central and hilar cholangiocarcinoma. Multicentric experience [Il trapianto ortotopico di fegato nel colangiocarcinoma periferico e dell'ilo epatico. Studio multicentrico]

In the early days of clinical liver transplantation (OLTX, peripheral and hilar colangiocellularcarcinoma (CCC) was considered an optimal indication for this surgical procedure together with other primary liver malignancies due to less difficult surgery and fewer postoperative complications in respect with cirrhotic patients. The initial enthusiasm has dampened because the high recurrence rate that brought almost all patients to death some months after transplantation. Some centers have continued to transplant patients with carcinoma of the bile duct system, peripheral and hilar (Klatskin's tumor) in location, in an effort to give at least some chance for cure in unresectable lesions. We present here our experience about 13 patients who underwent OLTX from April 1984 to December 1994 for CCC in two centers in Milan. According to TNM classification all peripheral CCC (5 patients) were T4 and all Klatskin tumor (8 patients) were B4 according Bismuth-Corlette classification. Postoperative mortality rate was 15.3% (2 patients). Excluding postoperative mortality overall and disease free survival at 1, 3, 5 years were respectively 89%, 53%, 53% and 67%, 53% 53%. No patients transplanted with limphonodal involement is alive at three years from OLTX