Asia-Pacific Transplant Oncology Symposium 2024: Expert Statements on the Current State and Future Direction of Hepatobiliary Surgical and Transplant Oncology.
38 affiliations
- 1Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore.
- 2Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, Alexandra Hospital, Singapore, Singapore.
- 3National University Centre for Organ Transplantation, National University Hospital, Singapore, Singapore.
- 4Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- 5Department of Liver Surgery and Liver Transplant Centre, Organ Transplant Centre, West China Hospital of Sichuan University, Chengdu, China.
- 6Department of Gastroenterology and Hepatology, Kindai University, Higashiosaka, Japan.
- 7Department of Gastroenterology and Hepatology, National University Hospital, Singapore, Singapore.
- 8Liver Transplant Program, UCSF, San Francisco, CA, USA.
- 9Division of Hepatology, HPB Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumouri, Milan, Italy.
- 10Department of Surgery and Cancer, Imperial College London, Faculty of Medicine, Hammersmith Hospital, London, UK.
- 11Department of Translational Medicine (DIMET), University of Piemonte Orientale "A. Avogadro," Novara, Italy.
- 12Department of Haematology-Oncology, National University Cancer Institute, Singapore, National University Health System, Singapore, Singapore.
- 13Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
- 14Department of Transplantation Medicine, University of Oslo, Oslo, Norway.
- 15Department of Clinical Oncology, Chinese University of Hong Kong, Hong Kong, Hong Kong SAR.
- 16Department of HPB and Transplant Surgery, Washington University in St. Louis, St. Louis, MO, USA.
- 17Medical Oncology Department, Hospital Clinic Barcelona, Translational Oncology in Upper Gastrointestinal Cancer Group, IDIBAPS, Barcelona, Spain.
- 18Department of Surgical Oncology, UT Southwestern Medical Centre, Dallas, TX, USA.
- 19Division of Gastroenterology and Hepatology, Toronto General Hospital, Toronto, ON, Canada.
- 20Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada.
- 21Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany.
- 22Department of HPB Surgery, Chiba University, Chiba, Japan.
- 23Department of Surgery, Nagoya University Hospital, Nagoya, Japan.
- 24Department of Liver Transplant Surgery, Ain Shams University, Cairo, Egypt.
- 25Department of Medical Oncology, St. Vincent's University Hospital, Dublin, Ireland.
- 26Department of HPB Surgery, Alexandria University, Alexandria, Egypt.
- 27Cancer Institute, University College London (UCL), UK, and Royal Free NHS Foundation Trust, London, UK.
- 28Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.
- 29Institute of Liver Transplantation and Regenerative Medicine, Medanta, The Medicity, Gurgaon, India.
- 30Department of Haematology and Oncology, UCLA, Los Angeles, CA, USA.
- 31Department of Surgery, The University of Hong Kong, Hong Kong, Hong Kong SAR.
- 32Department of Oncology and Haemato-Oncology, University of Milan, Milan, Italy.
- 33Department of Surgery, Korea University College of Medicine, Seoul, South Korea.
- 34Department of Hepatobiliary Surgery and Liver Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
- 35Hepatopancreatobiliary Centre, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
- 36Department of Paediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan.
- 37Department of Abdominal, General Surgery and Liver Transplantation, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
- 38Department of General Surgery and Transplantation University Health Network, University of Toronto, Toronto, ON, Canada.
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.
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BibTeX
@article{law2026asiapacific,
title = {{Asia-Pacific Transplant Oncology Symposium 2024: Expert Statements on the Current State and Future Direction of Hepatobiliary Surgical and Transplant Oncology.}},
author = {Jia-Hao Law and Kunlin Xie and Jiayin Yang and Masatoshi Kudo and Mark Dhinesh Muthiah and Neil Mehta and Sherrie Bhoori and David J Pinato and Cheng Ean Chee and Etsuro Hatano and Pål-Dag Line and Stephen L Chan and Majella Doyle and Teresa Macarulla and Adam Yopp and Arndt Vogel and Masayuki Ohtsuka and Tomoki Ebata and Mahmoud El-Meteini and Mohamed Fathy Abdelghafar and Grainne O'Kane and Ahmed El-Gendi and Tim Meyer and Suk Kyun Hong and Prashant Bhangui and Richard Finn and Albert C Y Chan and Vincenzo Mazzaferro and Dong-Sik Kim and Jian Zhou and Jiahong Dong and Taizo Hibi and Hong Wu and Gonzalo Sapisochin and Alfred Wei Chieh Kow},
journal = {Liver cancer},
year = {2026},
month = sep,
doi = {10.1159/lic/admag012},
url = {https://europepmc.org/article/MED/42910203},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Asia-Pacific Transplant Oncology Symposium 2024: Expert Statements on the Current State and Future Direction of Hepatobiliary Surgical and Transplant Oncology.
AU - Jia-Hao Law
AU - Kunlin Xie
AU - Jiayin Yang
AU - Masatoshi Kudo
AU - Mark Dhinesh Muthiah
AU - Neil Mehta
AU - Sherrie Bhoori
AU - David J Pinato
AU - Cheng Ean Chee
AU - Etsuro Hatano
AU - Pål-Dag Line
AU - Stephen L Chan
AU - Majella Doyle
AU - Teresa Macarulla
AU - Adam Yopp
AU - Arndt Vogel
AU - Masayuki Ohtsuka
AU - Tomoki Ebata
AU - Mahmoud El-Meteini
AU - Mohamed Fathy Abdelghafar
AU - Grainne O'Kane
AU - Ahmed El-Gendi
AU - Tim Meyer
AU - Suk Kyun Hong
AU - Prashant Bhangui
AU - Richard Finn
AU - Albert C Y Chan
AU - Vincenzo Mazzaferro
AU - Dong-Sik Kim
AU - Jian Zhou
AU - Jiahong Dong
AU - Taizo Hibi
AU - Hong Wu
AU - Gonzalo Sapisochin
AU - Alfred Wei Chieh Kow
PY - 2026
DA - 2026/09/05
JO - Liver cancer
DO - 10.1159/lic/admag012
UR - https://europepmc.org/article/MED/42910203
AB - 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.
SN - 2235-1795
SN - 1664-5553
ER -