Reply

Reply TO THE EDITOR:We thank Jeong et al. for their thoughtful comments on our recent review article. As discussed, we agree that in selected patients with hilar and intrahepatic cholangiocarcinoma (CCA), liver transplantation (LT) represents an excellent treatment option, achieving good longterm results. However, we would like to emphasize some remarks.So far, the favorable reported outcomes strongly support LT as an interesting strategy to successfully treat patients with very early (≤2 cm) unresectable intrahepatic CCA. Still, as mentioned in their letter, it is important to stress that there is a worldwide need for prospective trials that challenge this theory. This approach also extends to their reported good outcome of HBV‐associated ICC treated with resection and postoperative chemoembolization. Although this study shows interesting results, it exceeds the scope of our review and as previously discussed, prospective clinical trials comparing this to a more definitive treatment option such as LT would better assess the best approach for this patient population.As we enter a new era where the role of LT as a treatment option for other unresectable liver tumors expands beyond hepatocellular carcinoma, further research focusing on inclusion criteria and neoadjuvant and adjuvant treatments is desperately needed. In this manner, the best treatment option for each type of tumor in the different specific scenarios (ie, ICC arising in HBV patients) will potentially be identified.Nicolás Goldaracena, M.D.Andre Gorgen, M.D.Gonzalo Sapisochin, M.D.Multi‐Organ Transplant ProgramDivision of General SurgeryDepartment of SurgeryToronto General HospitalUniversity Health NetworkUniversity of TorontoToronto, Ontario, CanadaREFERENCESGoldaracena N, Gorgen A, Sapisochin G. Current status of liver transplantation for cholangiocarcinoma. Liver Transpl 2018;24:294‐303.Jeong S, Zheng B, Wang J, Chi J, Tong Y, Xia L, et al. Transarterial chemoembolization: a favorable postoperative management to improve prognosis of hepatitis B virus‐associated intrahepatic cholangiocarcinoma after surgical resection. Int J Biol Sci 2017;13:1234‐1241. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Liver Transplantation Wiley

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Publisher
Wiley Subscription Services, Inc., A Wiley Company
Copyright
© 2018 by the American Association for the Study of Liver Diseases.
ISSN
1527-6465
eISSN
1527-6473
D.O.I.
10.1002/lt.24971
Publisher site
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Abstract

TO THE EDITOR:We thank Jeong et al. for their thoughtful comments on our recent review article. As discussed, we agree that in selected patients with hilar and intrahepatic cholangiocarcinoma (CCA), liver transplantation (LT) represents an excellent treatment option, achieving good longterm results. However, we would like to emphasize some remarks.So far, the favorable reported outcomes strongly support LT as an interesting strategy to successfully treat patients with very early (≤2 cm) unresectable intrahepatic CCA. Still, as mentioned in their letter, it is important to stress that there is a worldwide need for prospective trials that challenge this theory. This approach also extends to their reported good outcome of HBV‐associated ICC treated with resection and postoperative chemoembolization. Although this study shows interesting results, it exceeds the scope of our review and as previously discussed, prospective clinical trials comparing this to a more definitive treatment option such as LT would better assess the best approach for this patient population.As we enter a new era where the role of LT as a treatment option for other unresectable liver tumors expands beyond hepatocellular carcinoma, further research focusing on inclusion criteria and neoadjuvant and adjuvant treatments is desperately needed. In this manner, the best treatment option for each type of tumor in the different specific scenarios (ie, ICC arising in HBV patients) will potentially be identified.Nicolás Goldaracena, M.D.Andre Gorgen, M.D.Gonzalo Sapisochin, M.D.Multi‐Organ Transplant ProgramDivision of General SurgeryDepartment of SurgeryToronto General HospitalUniversity Health NetworkUniversity of TorontoToronto, Ontario, CanadaREFERENCESGoldaracena N, Gorgen A, Sapisochin G. Current status of liver transplantation for cholangiocarcinoma. Liver Transpl 2018;24:294‐303.Jeong S, Zheng B, Wang J, Chi J, Tong Y, Xia L, et al. Transarterial chemoembolization: a favorable postoperative management to improve prognosis of hepatitis B virus‐associated intrahepatic cholangiocarcinoma after surgical resection. Int J Biol Sci 2017;13:1234‐1241.

Journal

Liver TransplantationWiley

Published: Jan 1, 2018

References

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