Evidence map›Paper›PMID 35894433›Full record

ArticleAnnals of surgery2022

Liver Transplantation as a New Standard of Care in Patients With Perihilar Cholangiocarcinoma? Results From an International Benchmark Study.

Eva Breuer, Matteo Mueller, Majella B Doyle, Liu Yang, Sarwa Darwish Murad, Imran J Anwar, Shaheed Merani, Ashley Limkemann, Heithem Jeddou, Steven C Kim and 25 more

Open access · greenAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Annals of surgery, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 35 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
35citing papers in PubMed, 1 pooled it
13.3field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

35 citing papers in PubMed, 1 synthesis or guideline pooled it, 65 citations in OpenAlex.

  1. Pooled it
  2. Review
  3. Article
  4. Outcomes of Liver Transplant Versus Partial Hepatectomy for Perihilar Cholangiocarcinoma Patients Requiring Arterial Reconstruction.Liver international : official journal of the International Association for the Study of the Liver · 2026
    Article
  5. Article
  6. Article
  7. Hospital variation in surgical outcomes for gastric cancer: the impact of case-mix and treatment across a global cohort.Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association · 2026
    Article
  8. Review
  9. Present and future of liver transplantation for cholangiocellular carcinoma: moving toward personalized multiparametric transplantability patterns.Transplant international : official journal of the European Society for Organ Transplantation · 2026
    Review
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  11. Article
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

35 authors at 16 institutions in 7 countries.

Eva BreuerDepartment of Surgery and Transplantation, Swiss HPB Center, University Hospital Zurich, Zurich, Switzerland.
Matteo MuellerDepartment of Surgery and Transplantation, Swiss HPB Center, University Hospital Zurich, Zurich, Switzerland.
Majella B DoyleBarnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO.
Liu YangDepartment of Transplant, Mayo Clinic Florida, Jacksonville, FL.
Sarwa Darwish MuradErasmus MC Transplant Institute, University Medical Center Rotterdam, Department of Gastroenterology and Hepatology, Rotterdam, The Netherlands.
Imran J AnwarDuke Transplant Center, Department of Surgery, Duke University School of Medicine, Durham, NC.
Shaheed MeraniDivision of Transplantation and Vascular Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE.
Ashley LimkemannDivision of Transplantation Surgery, The Ohio State University Wexner Medical, Columbus, OH.
Heithem JeddouDepartment of Hepatobiliary and Digestive Surgery, Pontchaillou University Hospital, Rennes, France.
Steven C KimDivision of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Victor López-LópezDepartment of Surgery and Liver and Pancreas Transplantation, Virgen de la Arrixaca Clinic and University Hospital, Murcia, Spain.
Ahmed NassarDepartment of Surgery, Emory University, Atlanta, GA.
Frederik J H HoogwaterSection of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Eric VibertThe Centre Hépato-Biliaire, Paul Brousse Hospital, Villejuif, France.
Michelle L De OliveiraDepartment of Surgery and Transplantation, Swiss HPB Center, University Hospital Zurich, Zurich, Switzerland.
Daniel CherquiThe Centre Hépato-Biliaire, Paul Brousse Hospital, Villejuif, France.
Robert J PorteSection of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Joseph F MaglioccaDepartment of Surgery, Emory University, Atlanta, GA.
Lutz FischerDepartment of Hepatobiliary Surgery and Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Constantino FondevilaDepartment of General and Digestive Surgery, Hospital Universitario La Paz, Madrid, Spain.
Krzysztof ZieniewiczDepartment of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
Pablo RamírezDepartment of Surgery and Liver and Pancreas Transplantation, Virgen de la Arrixaca Clinic and University Hospital, Murcia, Spain.
David P FoleyDivision of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Karim BoudjemaDepartment of Hepatobiliary and Digestive Surgery, Pontchaillou University Hospital, Rennes, France.
Austin D SchenkDivision of Transplantation Surgery, The Ohio State University Wexner Medical, Columbus, OH.
Alan N LangnasDivision of Transplantation and Vascular Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE.
Stuart KnechtleDuke Transplant Center, Department of Surgery, Duke University School of Medicine, Durham, NC.
Wojciech G PolakDivision of Hepatopancreatobiliary and Transplant Surgery, Erasmus MC Transplant Institute, Department of Surgery, University Medical Center Rotterdam, Rotterdam, The Netherlands.
C Burcin TanerDepartment of Transplant, Mayo Clinic Florida, Jacksonville, FL.
William C ChapmanBarnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO.
Charles B RosenDivision of Transplantation Surgery, Department of Surgery, Mayo Clinic, Rochester, MN.
Gregory J GoresDivision of Gastroenterology & Hepatology, Mayo Clinic, Rochester, MN.
Philipp DutkowskiDepartment of Surgery and Transplantation, Swiss HPB Center, University Hospital Zurich, Zurich, Switzerland.
Julie K HeimbachDivision of Transplantation Surgery, Department of Surgery, Mayo Clinic, Rochester, MN.
Pierre-Alain ClavienDepartment of Surgery and Transplantation, Swiss HPB Center, University Hospital Zurich, Zurich, Switzerland.ORCID 0000-0002-9916-7905
University Hospital of Zurich · CHDuke University · USErasmus MC · NLBarnes-Jewish Hospital · USEmory University · USHôpital Paul-Brousse · FRHospital Universitario Virgen de la Arrixaca · ESThe Ohio State University Wexner Medical Center · USUniversity Medical Center Groningen · NLUniversity of Nebraska Medical Center · USUniversity of Wisconsin–Madison · USWinnMed · USErasmus MC Cancer Institute · NLHospital Universitario La Paz · ESMedical University of Warsaw · PLUniversität Hamburg · DE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo define benchmark values for liver transplantation (LT) in patients with perihilar cholangiocarcinoma (PHC) enabling unbiased comparisons.

backgroundTransplantation for PHC is used with reluctance in many centers and even contraindicated in several countries. Although benchmark values for LT are available, there is a lack of specific data on LT performed for PHC.

methodsPHC patients considered for LT after Mayo-like protocol were analyzed in 17 reference centers in 2 continents over the recent 5-year period (2014-2018). The minimum follow-up was 1 year. Benchmark patients were defined as operated at high-volume centers (≥50 overall LT/year) after neoadjuvant chemoradiotherapy, with a tumor diameter <3 cm, negative lymph nodes, and with the absence of relevant comorbidities. Benchmark cutoff values were derived from the 75th to 25th percentiles of the median values of all benchmark centers.

resultsOne hundred thirty-four consecutive patients underwent LT after completion of the neoadjuvant treatment. Of those, 89.6% qualified as benchmark cases. Benchmark cutoffs were 90-day mortality ≤5.2%; comprehensive complication index at 1 year of ≤33.7; grade ≥3 complication rates ≤66.7%. These values were better than benchmark values for other indications of LT. Five-year disease-free survival was largely superior compared with a matched group of nodal negative patients undergoing curative liver resection (n=106) (62% vs 32%, P <0.001).

conclusionThis multicenter benchmark study demonstrates that LT offers excellent outcomes with superior oncological results in early stage PHC patients, even in candidates for surgery. This provocative observation should lead to a change in available therapeutic algorithms for PHC.

Indexed as

Bile Duct NeoplasmsCholangiocarcinomaKlatskin TumorLiver TransplantationBenchmarkingHumansStandard of Care

Identifiers

PMID35894433
PMCPMC9983747
OpenAlexW4288050526

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.