The goal of this study was to establish baseline values for perihilar cholangiocarcinoma (PHC) patients undergoing liver transplantation (LT), thereby allowing for objective comparisons to be made. Many hospitals are reluctant to employ transplantation for PHC, and the procedure is outright forbidden in other nations. There needs to be more data on LT conducted for PHC. Patients receiving PHC who were candidates for LT according to a Mayo-like approach were evaluated during the past 5 years at 17 reference centers on 2 continents (2014–2018). A year of observation was the bare minimum. Patients were considered benchmarks if they matched the following criteria: tumor diameter 3 cm, negative lymph nodes, lack of significant comorbidities, and surgery in high-volume centers (≥50 overall LT/year). The median values from all benchmark centers were used to calculate the benchmark cutoff values, which were then sorted from the 75th to 25th percentiles. After completing neoadjuvant therapy, 134 patients were treated in a row with LT. About 92% were considered representative examples. The 90-day mortality rate threshold was less than or equal to 5.2%, the 1-year comprehensive complication index was less than or equal to 33.7, and the rate of complications of a grade more than or equal to 3 was less than or equal to 66.7%. These numbers were superior to those used as standards for measuring other types of LT. Disease-free survival at 5 years was significantly higher in this cohort (62% vs. 32%, P<0.001) compared to a matched cohort of nodal-negative patients following curative liver resection (n=106). This international standard-setting trial reveals that LT provides superior oncological outcomes in early-stage PHC patients, including those who are surgical candidates. This thought-provoking finding should prompt a revision of current PHC therapy strategies.
