2023 Volume 37 Issue 2 Pages 175-184
Perihilar cholangiocarcinoma is an intractable cancer of which complete resection provides the only chance for a cure. Japanese hepatobiliary and pancreatic surgeons have pushed the envelope to improve prognoses by extended liver resection with concomitant vascular resection, pancreatic resection, etc. However, the outcomes of unresectable/borderline resectable patients at diagnosis remain dismal and standard regimen of pharmacological treatments only yields a survival rate of less than 10% at 5 years. Recently, liver transplantation as part of a multidisciplinary treatment for highly selected patients with unresectable disease has been advocated by Western countries. In the U.S., it has been approved as one of the standard indications for liver transplantation and the multicenter collaborative study published in 2012 reported an outstanding result of 65% recurrence-free survival at 5 years. When we deliberately consider perihilar cholangiocarcinoma from a "Transplant Oncology" perspective, an emerging concept we have proposed from Japan, liver resection and liver transplantation are considered to play complimentary roles to achieve "oncological eliminability." Japan is expected to fulfill the mission as a pioneer and leader in this field.
