Asia-Pacific Transplant Oncology Symposium 2024: Expert Statements on the Current State and Future Direction of Hepatobiliary Surgical and Transplant Oncology
Year: 2026
Type: review
Abstract: Background: Hepatobiliary oncology is at an inflection point. Parallel advances in surgical technique, locoregional therapy, systemic treatment, and understanding of tumour biology have expanded the boundaries of curative-intent care yet have also exposed a critical reality that technical resectability is not synonymous with oncologic resectability. Technically successful resection or liver transplantation may be futile when tumour biology is aggressive, leading to early recurrence and limited survival benefit. Modern hepatobiliary surgical and transplant oncology must therefore move beyond anatomy-driven decision-making towards biologically informed strategies that incorporate tumour behaviour, treatment response, and temporal disease stability. Summary: The Asia-Pacific Transplant Oncology Symposium (APTOS) 2024 examined how Eastern and Western paradigms intersect across hepatocellular carcinoma, cholangiocarcinoma, and colorectal liver metastases, identifying pathways towards integration. Eastern and Western programmes have historically approached hepatobiliary oncology through distinct and longstanding philosophies. Eastern centres, frequently operating within living donor liver transplantation-dominant systems characterized by organ scarcity and the ethical principle of double equipoise, have traditionally leveraged high operative volume and technical expertise in complex resections. These environments have favoured surgery-first approaches when resection appears technically feasible, alongside response-driven conversion strategies aimed at expanding operability. Western centres, shaped by deceased-donor allocation frameworks and trial-oriented oncology models, have more consistently prioritized biological selection and longitudinal validation of disease control before proceeding to curative-intent intervention, particularly in borderline-resectable disease. These differences are driven by infrastructural and ethical factors, including donor availability, transplant systems, and biomarker integration, rather than surgical capability. This article is an expert statement reflecting the opinion of an international multidisciplinary faculty of hepatobiliary surgeons, transplant surgeons, hepatologists, and medical and clinical oncologists from Eastern and Western centres. It is a narrative expert perspective and not a formal consensus or guideline. Key Messages: This expert statement proposes that the next phase of hepatobiliary oncology requires harmonized, biology-driven definitions of resectability, transplantability, and futility. Comparative evaluation of regional strategies is essential to clarify how treatment sequencing affects recurrence and survival, an effort that is time-sensitive as advances in systemic therapy may soon obscure strategy-specific effects. Rather than competing models, Eastern procedural expertise and Western biology-centred frameworks should be viewed as complementary, supporting context-dependent or sequential approaches that integrate surgery with biology-guided systemic or locoregional therapy. Aligning these paradigms within ethical stewardship of donor organs can establish globally coherent, biology-driven standards that maximize durable survival while minimizing futile surgery and transplantation.
Source: Liver Cancer
DOI: 10.1159/lic/admag012
Authors: Jia-Hao Law, Kunlin Xie, Jiayin Yang, Masatoshi Kudo, Mark Dhinesh Muthiah, Neil Mehta, Sherrie Bhoori, David J. Pinato, Cheng Ean Chee, Etsuro Hatano, Pål-Dag Line, Stephen L. Chan, Majella Doyle, Teresa Macarulla, Adam Yopp, Arndt Vogel, Masayuki Ohtsuka, Tomoki Ebata, Mahmoud El-Meteini, Mohamed Fathy Abdelghafar, Grainne O’Kane, Ahmed El-Gendi, Tim Meyer, Suk Kyun Hong, Prashant Bhangui, Richard Finn, Albert C.Y. Chan, Vincenzo Mazzaferro, Dong-Sik Kim, Jian Zhou, Jiahong Dong, Taizo Hibi, Hong Wu, Gonzalo Sapisochin, Alfred Wei Chieh Kow
Institutions: National University of Singapore, Alexandra Hospital, National University Hospital, National University Health System, West China Hospital of Sichuan University, Kindai University, University of California, San Francisco, Fondazione IRCCS Istituto Nazionale dei Tumori, Università degli Studi del Piemonte Orientale “Amedeo Avogadro”, Hammersmith Hospital, Imperial College London, National University Cancer Institute, Singapore, Kyoto University, University of Oslo, Chinese University of Hong Kong, Washington University in St. Louis, Hospital Clínic de Barcelona, Consorci Institut D'Investigacions Biomediques August Pi I Sunyer, The University of Texas Southwestern Medical Center, University of Toronto, Toronto General Hospital, Princess Margaret Cancer Centre, Medizinische Hochschule Hannover, Chiba University, Nagoya University Hospital, Ain Shams University, St. Vincent's University Hospital, Alexandria University, Royal Free London NHS Foundation Trust, The Royal Free Hospital, University College London, Seoul National University, Medanta The Medicity, Medanta The Medicity, University of California, Los Angeles, University of Hong Kong, University of Milan, Korea University, Korea University Medical Center, Fudan University, Zhongshan Hospital, Beijing Tsinghua Chang Gung Hospital, Tsinghua University, Kumamoto University, University Health Network, Vall d'Hebron Hospital Universitari
Language: English
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,590
OpenAlex ID: W7220712331