Outcomes of Liver Transplant Versus Partial Hepatectomy for Perihilar Cholangiocarcinoma Patients Requiring Arterial Reconstruction

Edoardo Poletto; Pim B. Olthof; Andrea Ruzzenente; Jean-Philippe Adam; Ian P. J. Alwayn; Emmanuel Boleslawski; Marieke T. de Boer; Alexandre Chebaro; Laurence Chiche; Cristina Dopazo; Jeroen Dubbeld; Joris I. Erdmann; Abdul Hakeem; Minneke J. Coenraad; Hendrien Kuipers; Jean-Yves Mabrut; Charlotte Maulat; Shishir K. Maithel; Vincent E. de Meijer; Kayvan Mohkam; Sarwa Darwish Murad; Fabrice Muscari; Jens Rolinger; Wojciech G. Polak; Michel Rayar; Francesca Ratti; Fabien Robin; Andreas A. Schnitzbauer; Ernesto Sparrelid; Frederike G. I. van Vilsteren; Robert J. Porte; Frederik J. H. Hoogwater; Bas Groot Koerkamp; the Perihilar Cholangiocarcinoma Collaboration Group

doi:10.1111/liv.70729

Outcomes of Liver Transplant Versus Partial Hepatectomy for Perihilar Cholangiocarcinoma Patients Requiring Arterial Reconstruction

Edoardo Poletto
, Pim B. Olthof
, Andrea Ruzzenente
, Jean-Philippe Adam
, Ian P. J. Alwayn
, Emmanuel Boleslawski
, Marieke T. de Boer
, Alexandre Chebaro
, Laurence Chiche
, Cristina Dopazo
, Jeroen Dubbeld
, Joris I. Erdmann
, Abdul Hakeem
, Minneke J. Coenraad
, Hendrien Kuipers
, Jean-Yves Mabrut
, Charlotte Maulat
, Shishir K. Maithel
, Vincent E. de Meijer
, Kayvan Mohkam

Sarwa Darwish Murad, Fabrice Muscari, Jens Rolinger, Wojciech G. Polak, Michel Rayar, Francesca Ratti, Fabien Robin, Andreas A. Schnitzbauer, Ernesto Sparrelid, Frederike G. I. van Vilsteren, Robert J. Porte^*, Frederik J. H. Hoogwater^*, Bas Groot Koerkamp^*, the Perihilar Cholangiocarcinoma Collaboration Group

^*Corresponding author for this work

University of Verona
Erasmus University Rotterdam
University of Groningen
Service d'information médicale
Leiden University
Université de Lille
Vall d'Hebron Research Institute
University of Amsterdam
Leeds Teaching Hospitals NHS Trust
Hôpital de la Croix-Rousse
CHU de Toulouse
Emory University
University of Tübingen
CHU de Rennes
Institut national de la santé et de la recherche médicale
IRCCS Ospedale San Raffaele
Goethe University Frankfurt
Karolinska Institutet

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background and Aims: Liver resection (LR) and orthotopic liver transplantation (OLT) are therapeutic options for locally advanced perihilar cholangiocarcinoma (pCCA) requiring hepatic artery reconstruction (HAR). This study aimed to compare short- and long-term outcomes of LR and OLT. Outcomes were major vascular complications, 90-day mortality, overall survival (OS) and recurrence-free survival (RFS). Methods: A cohort of patients undergoing LR with HAR from 10 Western centres was compared with an OLT cohort comprising patients who received or did not receive neoadjuvant chemoradiotherapy (NACR). Results: 109 patients, 60 LR and 49 OLT (22 OLT no-NACR and 27 OLT NACR) were included. LR patients were older and had fewer Bismuth type 4 tumours (38.3% vs. 69.4%, p = 0.009). Positive margins (49.2% vs. 6.5%, p < 0.001) and lymph nodes (54.2% vs. 32.4%, p = 0.058) were found more frequently in LR patients. No differences were found between LR and OLT in major (40% vs. 46.9%, p = 0.56) and vascular complications (23.3% vs. 28.6%, p = 0.66); NACR was an independent prognostic factor for vascular complications (OR 2.63, 95% CI 1.03–6.70, p = 0.043). 90-day mortality (15% for LR vs. 10.2% for OLT, p = 0.57) and 5-year OS (HR 0.68, 95% CI 0.40–1.17, p = 0.17) were similar. Median OS after LR versus OLT was higher but not significant (24 vs. 40 months, p = 0.13). OLT had better 5-year RFS (HR 0.52, 95% CI 0.29–0.96, p = 0.035) than LR. R1 resection (HR 2.07, 95% CI 1.03–4.18, p = 0.041) and perineural invasion (HR 3.64, 95% CI 1.09–12.16, p = 0.035) were independent prognostic factors for RFS. Conclusions: LR and OLT for locally advanced pCCA had similar rates of major complications and post-operative mortality, but NACR was associated with increased vascular complications. Survival was difficult to compare in the groups due to their heterogeneity, but OLT, especially with NACR, seems to give better results than LR.

Original language	English
Article number	e70729
Journal	Liver international
Volume	46
Issue number	7
DOIs	https://doi.org/10.1111/liv.70729
Publication status	Published - 1 Jul 2026

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

biliary tract tumours
cholangiocarcinoma
liver resection
transplantation surgery
vascular reconstruction
vascular resection

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10.1111/liv.70729

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Poletto, E., Olthof, P. B., Ruzzenente, A., Adam, J.-P., Alwayn, I. P. J., Boleslawski, E., de Boer, M. T., Chebaro, A., Chiche, L., Dopazo, C., Dubbeld, J., Erdmann, J. I., Hakeem, A., Coenraad, M. J., Kuipers, H., Mabrut, J.-Y., Maulat, C., Maithel, S. K., de Meijer, V. E., ... the Perihilar Cholangiocarcinoma Collaboration Group (2026). Outcomes of Liver Transplant Versus Partial Hepatectomy for Perihilar Cholangiocarcinoma Patients Requiring Arterial Reconstruction. Liver international, 46(7), Article e70729. https://doi.org/10.1111/liv.70729

@article{f20204a26e3b409393bf6d849b164dcb,

title = "Outcomes of Liver Transplant Versus Partial Hepatectomy for Perihilar Cholangiocarcinoma Patients Requiring Arterial Reconstruction",

abstract = "Background and Aims: Liver resection (LR) and orthotopic liver transplantation (OLT) are therapeutic options for locally advanced perihilar cholangiocarcinoma (pCCA) requiring hepatic artery reconstruction (HAR). This study aimed to compare short- and long-term outcomes of LR and OLT. Outcomes were major vascular complications, 90-day mortality, overall survival (OS) and recurrence-free survival (RFS). Methods: A cohort of patients undergoing LR with HAR from 10 Western centres was compared with an OLT cohort comprising patients who received or did not receive neoadjuvant chemoradiotherapy (NACR). Results: 109 patients, 60 LR and 49 OLT (22 OLT no-NACR and 27 OLT NACR) were included. LR patients were older and had fewer Bismuth type 4 tumours (38.3\% vs. 69.4\%, p = 0.009). Positive margins (49.2\% vs. 6.5\%, p < 0.001) and lymph nodes (54.2\% vs. 32.4\%, p = 0.058) were found more frequently in LR patients. No differences were found between LR and OLT in major (40\% vs. 46.9\%, p = 0.56) and vascular complications (23.3\% vs. 28.6\%, p = 0.66); NACR was an independent prognostic factor for vascular complications (OR 2.63, 95\% CI 1.03{\textendash}6.70, p = 0.043). 90-day mortality (15\% for LR vs. 10.2\% for OLT, p = 0.57) and 5-year OS (HR 0.68, 95\% CI 0.40{\textendash}1.17, p = 0.17) were similar. Median OS after LR versus OLT was higher but not significant (24 vs. 40 months, p = 0.13). OLT had better 5-year RFS (HR 0.52, 95\% CI 0.29{\textendash}0.96, p = 0.035) than LR. R1 resection (HR 2.07, 95\% CI 1.03{\textendash}4.18, p = 0.041) and perineural invasion (HR 3.64, 95\% CI 1.09{\textendash}12.16, p = 0.035) were independent prognostic factors for RFS. Conclusions: LR and OLT for locally advanced pCCA had similar rates of major complications and post-operative mortality, but NACR was associated with increased vascular complications. Survival was difficult to compare in the groups due to their heterogeneity, but OLT, especially with NACR, seems to give better results than LR.",

keywords = "biliary tract tumours, cholangiocarcinoma, liver resection, transplantation surgery, vascular reconstruction, vascular resection",

author = "Edoardo Poletto and Olthof, \{Pim B.\} and Andrea Ruzzenente and Jean-Philippe Adam and Alwayn, \{Ian P. J.\} and Emmanuel Boleslawski and \{de Boer\}, \{Marieke T.\} and Alexandre Chebaro and Laurence Chiche and Cristina Dopazo and Jeroen Dubbeld and Erdmann, \{Joris I.\} and Abdul Hakeem and Coenraad, \{Minneke J.\} and Hendrien Kuipers and Jean-Yves Mabrut and Charlotte Maulat and Maithel, \{Shishir K.\} and \{de Meijer\}, \{Vincent E.\} and Kayvan Mohkam and Murad, \{Sarwa Darwish\} and Fabrice Muscari and Jens Rolinger and Polak, \{Wojciech G.\} and Michel Rayar and Francesca Ratti and Fabien Robin and Schnitzbauer, \{Andreas A.\} and Ernesto Sparrelid and \{van Vilsteren\}, \{Frederike G. I.\} and Porte, \{Robert J.\} and Hoogwater, \{Frederik J. H.\} and \{Groot Koerkamp\}, Bas and \{the Perihilar Cholangiocarcinoma Collaboration Group\} and L. Aldrighetti and Bechstein, \{W. O.\} and \{de Boer\}, \{M. A.\} and S. B{\"u}ttner and I. Capobianco and R. Charco and Franken, \{L. C.\} and S. Gilg and C. Gomez-Gavara and A. Guglielmi and \{van Gulik\}, \{T. M.\} and J. Heil and H. Jansson and G. Kazemier and P. Lodge and R. Marino and S. Nadalin and Nguyen, \{T. A.\} and R. Prasad",

note = "Publisher Copyright: {\textcopyright} 2026 The Author(s). Liver International published by John Wiley \& Sons Ltd.",

year = "2026",

month = jul,

day = "1",

doi = "10.1111/liv.70729",

language = "English",

volume = "46",

journal = "Liver international",

issn = "1478-3223",

publisher = "Wiley Blackwell",

number = "7",

}

Poletto, E, Olthof, PB, Ruzzenente, A, Adam, J-P, Alwayn, IPJ, Boleslawski, E, de Boer, MT, Chebaro, A, Chiche, L, Dopazo, C, Dubbeld, J, Erdmann, JI, Hakeem, A, Coenraad, MJ, Kuipers, H, Mabrut, J-Y, Maulat, C, Maithel, SK, de Meijer, VE, Mohkam, K, Murad, SD, Muscari, F, Rolinger, J, Polak, WG, Rayar, M, Ratti, F, Robin, F, Schnitzbauer, AA, Sparrelid, E, van Vilsteren, FGI, Porte, RJ, Hoogwater, FJH, Groot Koerkamp, B & the Perihilar Cholangiocarcinoma Collaboration Group 2026, 'Outcomes of Liver Transplant Versus Partial Hepatectomy for Perihilar Cholangiocarcinoma Patients Requiring Arterial Reconstruction', Liver international, vol. 46, no. 7, e70729. https://doi.org/10.1111/liv.70729

TY - JOUR

T1 - Outcomes of Liver Transplant Versus Partial Hepatectomy for Perihilar Cholangiocarcinoma Patients Requiring Arterial Reconstruction

AU - Poletto, Edoardo

AU - Olthof, Pim B.

AU - Ruzzenente, Andrea

AU - Adam, Jean-Philippe

AU - Alwayn, Ian P. J.

AU - Boleslawski, Emmanuel

AU - de Boer, Marieke T.

AU - Chebaro, Alexandre

AU - Chiche, Laurence

AU - Dopazo, Cristina

AU - Dubbeld, Jeroen

AU - Erdmann, Joris I.

AU - Hakeem, Abdul

AU - Coenraad, Minneke J.

AU - Kuipers, Hendrien

AU - Mabrut, Jean-Yves

AU - Maulat, Charlotte

AU - Maithel, Shishir K.

AU - de Meijer, Vincent E.

AU - Mohkam, Kayvan

AU - Murad, Sarwa Darwish

AU - Muscari, Fabrice

AU - Rolinger, Jens

AU - Polak, Wojciech G.

AU - Rayar, Michel

AU - Ratti, Francesca

AU - Robin, Fabien

AU - Schnitzbauer, Andreas A.

AU - Sparrelid, Ernesto

AU - van Vilsteren, Frederike G. I.

AU - Porte, Robert J.

AU - Hoogwater, Frederik J. H.

AU - Groot Koerkamp, Bas

AU - the Perihilar Cholangiocarcinoma Collaboration Group

AU - Aldrighetti, L.

AU - Bechstein, W. O.

AU - de Boer, M. A.

AU - Büttner, S.

AU - Capobianco, I.

AU - Charco, R.

AU - Franken, L. C.

AU - Gilg, S.

AU - Gomez-Gavara, C.

AU - Guglielmi, A.

AU - van Gulik, T. M.

AU - Heil, J.

AU - Jansson, H.

AU - Kazemier, G.

AU - Lodge, P.

AU - Marino, R.

AU - Nadalin, S.

AU - Nguyen, T. A.

AU - Prasad, R.

PY - 2026/7/1

Y1 - 2026/7/1

N2 - Background and Aims: Liver resection (LR) and orthotopic liver transplantation (OLT) are therapeutic options for locally advanced perihilar cholangiocarcinoma (pCCA) requiring hepatic artery reconstruction (HAR). This study aimed to compare short- and long-term outcomes of LR and OLT. Outcomes were major vascular complications, 90-day mortality, overall survival (OS) and recurrence-free survival (RFS). Methods: A cohort of patients undergoing LR with HAR from 10 Western centres was compared with an OLT cohort comprising patients who received or did not receive neoadjuvant chemoradiotherapy (NACR). Results: 109 patients, 60 LR and 49 OLT (22 OLT no-NACR and 27 OLT NACR) were included. LR patients were older and had fewer Bismuth type 4 tumours (38.3% vs. 69.4%, p = 0.009). Positive margins (49.2% vs. 6.5%, p < 0.001) and lymph nodes (54.2% vs. 32.4%, p = 0.058) were found more frequently in LR patients. No differences were found between LR and OLT in major (40% vs. 46.9%, p = 0.56) and vascular complications (23.3% vs. 28.6%, p = 0.66); NACR was an independent prognostic factor for vascular complications (OR 2.63, 95% CI 1.03–6.70, p = 0.043). 90-day mortality (15% for LR vs. 10.2% for OLT, p = 0.57) and 5-year OS (HR 0.68, 95% CI 0.40–1.17, p = 0.17) were similar. Median OS after LR versus OLT was higher but not significant (24 vs. 40 months, p = 0.13). OLT had better 5-year RFS (HR 0.52, 95% CI 0.29–0.96, p = 0.035) than LR. R1 resection (HR 2.07, 95% CI 1.03–4.18, p = 0.041) and perineural invasion (HR 3.64, 95% CI 1.09–12.16, p = 0.035) were independent prognostic factors for RFS. Conclusions: LR and OLT for locally advanced pCCA had similar rates of major complications and post-operative mortality, but NACR was associated with increased vascular complications. Survival was difficult to compare in the groups due to their heterogeneity, but OLT, especially with NACR, seems to give better results than LR.

AB - Background and Aims: Liver resection (LR) and orthotopic liver transplantation (OLT) are therapeutic options for locally advanced perihilar cholangiocarcinoma (pCCA) requiring hepatic artery reconstruction (HAR). This study aimed to compare short- and long-term outcomes of LR and OLT. Outcomes were major vascular complications, 90-day mortality, overall survival (OS) and recurrence-free survival (RFS). Methods: A cohort of patients undergoing LR with HAR from 10 Western centres was compared with an OLT cohort comprising patients who received or did not receive neoadjuvant chemoradiotherapy (NACR). Results: 109 patients, 60 LR and 49 OLT (22 OLT no-NACR and 27 OLT NACR) were included. LR patients were older and had fewer Bismuth type 4 tumours (38.3% vs. 69.4%, p = 0.009). Positive margins (49.2% vs. 6.5%, p < 0.001) and lymph nodes (54.2% vs. 32.4%, p = 0.058) were found more frequently in LR patients. No differences were found between LR and OLT in major (40% vs. 46.9%, p = 0.56) and vascular complications (23.3% vs. 28.6%, p = 0.66); NACR was an independent prognostic factor for vascular complications (OR 2.63, 95% CI 1.03–6.70, p = 0.043). 90-day mortality (15% for LR vs. 10.2% for OLT, p = 0.57) and 5-year OS (HR 0.68, 95% CI 0.40–1.17, p = 0.17) were similar. Median OS after LR versus OLT was higher but not significant (24 vs. 40 months, p = 0.13). OLT had better 5-year RFS (HR 0.52, 95% CI 0.29–0.96, p = 0.035) than LR. R1 resection (HR 2.07, 95% CI 1.03–4.18, p = 0.041) and perineural invasion (HR 3.64, 95% CI 1.09–12.16, p = 0.035) were independent prognostic factors for RFS. Conclusions: LR and OLT for locally advanced pCCA had similar rates of major complications and post-operative mortality, but NACR was associated with increased vascular complications. Survival was difficult to compare in the groups due to their heterogeneity, but OLT, especially with NACR, seems to give better results than LR.

KW - biliary tract tumours

KW - cholangiocarcinoma

KW - liver resection

KW - transplantation surgery

KW - vascular reconstruction

KW - vascular resection

UR - https://www.scopus.com/pages/publications/105042587020

U2 - 10.1111/liv.70729

DO - 10.1111/liv.70729

M3 - Article

C2 - 42324714

SN - 1478-3223

VL - 46

JO - Liver international

JF - Liver international

IS - 7

M1 - e70729

ER -

Outcomes of Liver Transplant Versus Partial Hepatectomy for Perihilar Cholangiocarcinoma Patients Requiring Arterial Reconstruction

Abstract

UN SDGs

Keywords

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