Liver Transplantation for Unresectable Perihilar Cholangiocarcinoma: A Case Report Following a Strict Oncologic Selection Protocol

Abstract

Perihepatic cholangiocarcinoma (pCCA) is one of the most challenging hepatobiliary tumors to treat in terms
of surgical complexity and poor prognosis in unresectable cases. In selected patients without metastatic
disease, liver transplantation (LT) performed according to a protocol that includes neoadjuvant therapy
has emerged as an accepted curative option. We present the case of a 52-year-old man with unresectable
pCCA due to bilateral vascular involvement, who was treated according to a strict institutional protocol that included neoadjuvant chemoradiotherapy and orthotopic liver transplantation. Despite recurrent episodes of cholangitis during follow-up, tumor markers remained normal, and a staging laparoscopy ruled out distant metastases. Cadaveric liver transplantation was successfully performed without significant intraoperative complications. This case demonstrates the feasibility and favorable outcomes of standardized transplantation for unresectable pCCA, supporting its implementation in specialized centers with carefully selected patients. Liver transplantation following a protocol offers the possibility of prolonged survival in cases where curative options have historically been unavailable.