Biliary tract cancer is aggressive cancer with a poor prognosis. The tumour is inoperable at the time of diagnosis, and the proposed treatment is palliative. However, as the experience of some centres, such as the Mayo Clinic in the United States and the Charite Hospital in Berlin, has shown, liver transplantation at an early stage of this cancer is possible, provided selected patients are qualified. This procedure can be implemented and gives good results by using a specialised protocol, including precise diagnostic imaging and radiotherapy, and chemotherapy as preparation for surgery. Liver transplantation in patients with biliary tract cancer has not yet been performed in Poland under such highly specialised protocols.
- Biliary tract cancer develops frequently in patients with primary sclerosing cholangitis (PSC). Several hundred patients diagnosed with PSC are under the care of the Centre for Treatment of Rare Liver Diseases at the Department of Hepatology and Internal Medicine, Medical University of Warsaw. This cancer can also affect young people and is sometimes diagnosed relatively early. Therefore, we decided to adopt and implement the protocol from the Mayo Clinic in the United States in our centre - Prof. Piotr Milkiewicz, who heads the Clinic and the Centre, said. Prof. Maciej Wójcicki carried out adaptation of the procedures to our conditions from the Department of Hepatology and Internal Diseases of the Medical University of Warsaw and dr Leszek Kraj from the Department of Oncology of the Medical University of Warsaw, headed by Prof. Rafał Stec. This multistage procedure also required cooperation with the team of the Radiotherapy Department of the National Institute of Oncology in Warsaw, with Prof. Lucjan Wyrwicz, dr Katarzyna Pędziwiatr and dr Małgorzata Gidzińska-Wielgosz.
The first patient, a 61-year-old patient with PSC and confirmed cholangiocarcinoma, after preparation with radio- and chemotherapy according to the Mayo Clinic protocol, underwent liver transplantation on 21 October this year in the Department of General, Transplant and Liver Surgery headed by Prof. Krzysztof Zieniewicz. The transplantation was performed by dr Piotr Smoter (pictured) and his team. The operation and postoperative period went without significant complications, and the patient was discharged home in good condition three weeks after the procedure.
- The histopathological result from the removed liver is auspicious. Indeed, viable bile duct tumour tissues accounted for less than 5 per cent of the tumour tissue. This demonstrates the high efficacy of the radiotherapy and chemotherapy protocol used before transplantation. It also confirms the importance of a multidisciplinary approach to complex problems involving different specialities in modern medicine. We hope that in the near future, more patients with this severe cancer will get a chance for transplantation and thus long-term survival - says dr Leszek Kraj.