Thursday, December 02, 2010
SCOTTSDALE, Ariz. — In what is a rare occurrence for all but a handful of U.S. medical centers, Mayo Clinic in Arizona is treating a life-threatening cancer of the bile duct by performing a liver transplant — an aggressive protocol that is exhibiting dramatic increases in survival rates, offering new hope for patients with this complex disease.
Mayo Clinic is one of only two liver transplant programs in the region of the U.S. that encompasses Arizona, California, Utah, Nevada and New Mexico performing liver transplants to treat Cholangiocarcinoma, a relatively rare bile duct cancer.
Moreover, Mayo Clinic is the only medical center doing living donor liver transplantation as a treatment protocol for Cholangiocarcinoma. In such a procedure, a healthy person donates half or slightly more of his or her liver to a family member or close friend who otherwise would be on a waiting list. Living donor liver transplants are performed because of the increased number of patients on the liver transplant waiting list and the shortage of available organs. An advantage for both the donor and recipient is that the surgeries can be performed at optimal times for both patients — and before the recipient becomes too ill to withstand the transplant surgery itself.
The living donor liver transplant program at Mayo Clinic in Arizona ranks in the top five programs in the nation and is the largest program in the Western U.S.
Cholangiocarcinoma is a malignant tumor of the bile duct (accounting for less than 1 percent of all cancers) that is most frequently found in the ducts located close to the liver. Such tumors are often resistant to treatment because the tumor can extend deep into the liver, making it difficult — if not impossible — to remove through conventional surgical methods. The conventional method for bile duct cancer is to remove or "resect" the tumor, which may require removing part of the liver. Survival rates have not been promising because of the potential spread of the cancer within the liver.
The major advantage of liver transplants to treat the rare bile duct cancer is that removal of the patient's entire liver also enables removal of the tumor itself, which in turn can mean a greater chance of longer-term survival. Until recently, such patients had few treatment options.
"By performing liver transplants for qualified patients with Cholangiocarcinoma, we are able to remove the entire liver, and therefore have more opportunity to remove the tumor itself, said David Douglas, M.D., Medical Director of Liver Transplantation at Mayo Clinic. "Patients have a much better prognosis in terms of living longer and a better quality of life."
Longer-term survival is also enhanced by the addition of radiation therapy and chemotherapy, a combined treatment that begins prior to transplantation. This protocol is administered to lessen the risk that the tumor could spread to lymph nodes or other areas.
"The complexities involved in treating Cholangiocarcinoma require a skilled, multidisciplinary team of experts to work toward the common goal of prolonged, disease-free survival for the patient," said Dr. Douglas. At Mayo Clinic, multiple review conferences are held, and patient clinics are staffed by providers from Hepatology, Transplant Surgery, Medical and Radiation Oncology.
Mayo recently performed two living donor liver transplants in one week for bile duct cancer, following comprehensive evaluation of both the donors and recipients as to their suitability for the living donor procedure.
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