Trasplante hepático en colangiocarcinoma hiliar irresecable

Trasplante hepático en colangiocarcinoma hiliar irresecable

Liver transplantation in unresectable hiliary cholangiocarcinoma

Marta Chacón Carrasco*, Félix Cambra Molero*, Sofía Faro Puente*, Carmelo Loinaz Segurola*

* Servicio de Cirugía General, Aparato Digestivo y Trasplante de Órganos Abdominales. Hospital 12 de Octubre. Madrid.

DOI: https://doi.org/10.14679/5202

Resumen:

Introducción: El colangiocarcinoma hiliar representa el 50–60% de los colangiocarcinomas. Algunos son irresecables inicialmente debido a infiltración vascular, invasión biliar proximal o enfermedad extensa. Aunque la resección R0 es el objetivo terapéutico, pocos pacientes son candidatos. Los nuevos protocolos neoadyuvantes han permitido ofrecer el trasplante hepático como tratamiento curativo en colangiocarcinoma hiliar irresecable.
Caso clínico: Varón de 23 años con colitis ulcerosa y colangitis esclerosante primaria (CEP) que presenta una masa de 2 cm en la confluencia biliar, compatible con colangiocarcinoma tipo IIIb. Debido a su hepatopatía crónica, tras evaluación multidisciplinar, inicia tratamiento neoadyuvante y, descartada la afectación ganglionar, se incluye en lista de trasplante hepático. El trasplante se realiza sin incidencias y la evolución postoperatoria es favorable. La anatomía patológica confirma un colangiocarcinoma bien diferenciado y neoplasia intraepitelial de alto grado (BILIN). El paciente completa posteriormente la quimioterapia adyuvante.
Conclusión: El trasplante hepático, aplicado dentro de un protocolo neoadyuvante y con criterios estrictos de selección, constituye una alternativa curativa eficaz para pacientes con colangiocarcinoma irresecable, especialmente en presencia de CEP.
Palabras Clave: Colangiocarcinoma hiliar; trasplante hepático; tratamiento neoadyuvante; colangitis esclerosante primaria; colangiocarcinoma irresecable.

Abstract:

Introduction: Hilar cholangiocarcinoma accounts for 50–60% of all cholangiocarcinomas. Some cases are initially unresectable due to vascular involvement, proximal biliary invasion, or extensive disease. Although achieving an R0 resection is the therapeutic goal, few patients are suitable candidates. New neoadjuvant protocols have made it possible to offer liver transplantation as a curative treatment for unresectable hilar cholangiocarcinoma.
Case report: A 23yearold man with ulcerative colitis and primary sclerosing cholangitis (PSC) presented with a 2cm mass at the biliary confluence, consistent with a type IIIb cholangiocarcinoma. Due to his underlying chronic liver disease, and following multidisciplinary evaluation, he initiated neoadjuvant therapy and, after nodal involvement was ruled out, was listed for liver transplantation. The transplant was performed without complications, and the postoperative course was favorable. Pathology confirmed a welldifferentiated cholangiocarcinoma along with highgrade biliary intraepithelial neoplasia (BilIN). The patient subsequently completed adjuvant chemotherapy.
Conclusion: Liver transplantation, when performed within a neoadjuvant protocol and under strict selection criteria, represents an effective curative option for patients with unresectable cholangiocarcinoma, particularly in the presence of PSC..
Key words: Hilar cholangiocarcinoma; liver transplantation; neoadjuvant therapy; primary sclerosing cholangitis; unresectable colangiocarcinoma.

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