Zhou RQ, Yang PJ, Liu TT, Han DD, Liu XL, Liu LG, Si S, Yang SW, Xu SS, Guo YW, Tan HD. Liver transplantation for combined hepatocellular cholangiocarcinoma: Current evidence, selection criteria, and therapeutic controversies. World J Gastrointest Surg 2025; 17(5): 105783 [DOI: 10.4240/wjgs.v17.i5.105783]
Corresponding Author of This Article
Hai-Dong Tan, MD, Chief Physician, Second Department of Hepatopancreatobiliary Surgery, China-Japan Friendship Hospital, No. 2 Yinghua Dongjie, Hepingli, Beijing 100029, China. hpblt_cjfh@126.com
Research Domain of This Article
Surgery
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Rui-Quan Zhou, Pei-Jun Yang, Tian-Tong Liu, Dong-Dong Han, Xiao-Lei Liu, Li-Guo Liu, Shuang Si, Shi-Wei Yang, Shuai-Shuai Xu, Yi-Wen Guo, Hai-Dong Tan, Second Department of Hepatopancreatobiliary Surgery, China-Japan Friendship Hospital, Beijing 100029, China
Author contributions: Zhou RQ, Yang PJ, Liu TT, Xu SS, and Guo YW were responsible for the literature search and writing; Han DD, Liu XL, Liu LG, Si S, and Yang SW were responsible for the manuscript revision; Tan HD was responsible for the supervision and manuscript revision.
Supported by High-level Research Projects of China-Japan Friendship Hospital, No. 2022-NHLHCRF-LX-03-0301 and No. 2023-NHLHCRF-LXYZ-01.
Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hai-Dong Tan, MD, Chief Physician, Second Department of Hepatopancreatobiliary Surgery, China-Japan Friendship Hospital, No. 2 Yinghua Dongjie, Hepingli, Beijing 100029, China. hpblt_cjfh@126.com
Received: February 8, 2025 Revised: March 9, 2025 Accepted: April 9, 2025 Published online: May 27, 2025 Processing time: 105 Days and 0.8 Hours
Abstract
Combined hepatocellular cholangiocarcinoma (cHCC-CCA) is a rare and aggressive primary liver malignancy characterized by features of both HCC and CCA. Preoperative diagnosis remains challenging because of overlapping imaging and histopathological features, which often lead to misclassification. Although liver resection is the primary curative therapy, the efficacy of liver transplantation (LT) remains controversial. Historically, LT has been considered contraindicated owing to the poor prognosis, high recurrence rate of cHCC-CCA, and the potential for organ wastage. Recent studies have suggested that LT may benefit carefully selected patients, particularly those with early-stage tumors or cirrhosis. However, there is no consensus on the criteria for LT in patients with cHCC-CCA. Lymphadenectomy and vascular resection strategies were discussed along with locoregional and systemic therapies. This review synthesized the current evidence on surgical strategies for cHCC-CCA, focusing on evolving LT criteria and outcomes.
Core Tip: Combined hepatocellular cholangiocarcinoma is a rare and aggressive liver malignancy with diagnostic and therapeutic challenges. Although surgical resection remains the primary curative approach, liver transplantation is emerging as a potential option for carefully selected patients, particularly those with early-stage tumors or cirrhosis. Adherence to stringent selection criteria, such as the Milan criteria, is crucial for optimizing post-transplant outcomes. Ongoing research aims to refine the selection framework and to improve prognostic accuracy.
