Comparative prognosis of liver transplantation versus liver resection in intrahepatic cholangiocarcinoma: a systematic review and meta-analysis

Background: Liver resection (LR) remains the only curative approach for patients diagnosed with intrahepatic cholangiocarcinoma (ICC). Although margin-negative resection can be achieved, long-term oncological outcomes still need improvement. Recent studies from both single and multi-institutional settings have indicated that liver transplantation (LT) could be a feasible treatment option for ICC under particular conditions. While some research has compared LT with LR in treating ICC patients, the results of these comparisons remain controversial. This meta-analysis compares the surgical outcomes of LT and LR for ICC. Methods: We conducted a thorough search of the Cochrane Library, Web of Science, and PubMed for articles comparing the ICC of LT and LR published from January 2000 to April 2024. The studies' relevance and quality were assessed independently by two investigators. Odds ratios (ORs) were utilized to evaluate dichotomous data, and fixed-effects were employed for meta-analyses. Results: Five studies were analyzed in this meta-analysis, revealing no significant difference in 1-year overall survival rates between LT and LR. However, LT showed significantly higher 3-year, and 5-year overall survival rates compared to LR, with ORs of 1.39 [95% confidence interval (CI): 1.04-1.84, P=0.02] at 3 years, 1.71 (95% CI: 1.30-2.26, P<0.001) at 5 years. The advantage of LT over LR in terms of overall survival became evident at 3 years, 5 years, and post-operation, despite not being apparent in the first year. Additionally, the R0 resection rate was higher following LT than LR (P=0.006), potentially contributing to the superior long-term outcomes of LT. Subgroup analysis revealed no statistically significant difference in survival outcomes between the two treatment regimens when LT failed to achieve R0 resection. Conclusions: For patients with ICC, LT seems to have optimistic survival results under certain conditions compared with curative hepatectomy. Since LT is a potential treatment for ICC, it is currently uncertain whether LT should be more considered in patients with ICC. Further prospective trials are required to demonstrate its efficacy in the future.