Surgical Resection for Recurrent Intrahepatic Cholangiocarcinoma
Although after R0 resection of intrahepatic cholangiocarcinoma (ICC) recurrence is frequent, most guidelines do not address strategies for this. The aim of this study was to analyze the outcome of repeated resection and to determine criteria when repeated resection is reasonable.
Between 2008 and 2016, we consecutively collected all cases of ICC (n = 176) in a prospective database and further analyzed them with a focus on tumor recurrence, its surgical treatment, overall survival and recurrence-free survival.
Overall, a total of 22 explorations were performed for recurrent ICC in 17 patients. Resection rate was 18 repeated resections in 13 patients. Three patients underwent repeated resection twice and one patient three times. Recurrence was solitary in 7 patients and multifocal in 11 re-resected cases. Median overall survival (OS) of patients who underwent repeated resection was 65.2 months (interquartile range 37–126.5) with a 5-year OS rate of 62%, calculated from primary resection. Patients who underwent repeated resections had a significant better OS compared to those receiving chemotherapy, transarterial chemoembolization, selective internal radiotherapy, radiofrequency ablation or best supportive care (p < 0.001).
Repeated resection of recurrent ICC is reasonable and associated with an improved survival. Re-exploration should be considered as long as resection is technically possible.
Compliance with ethical standards
Conflict of interest
There are no conflicts to declare or financial relationships to disclose.
- 9.Bartsch F, Baumgart J, Hoppe-Lotichius M, Schmidtmann I, Heinrich S, Lang H (2018) Visceral infiltration of intrahepatic cholangiocarcinoma is most prognostic after curative resection—retrospective cohort study of 102 consecutive liver resections from a single center. Int J Surg 55:193–200CrossRefGoogle Scholar
- 18.Alvaro D, Cannizzaro R, Labianca R, Valvo F, Farinati F, Italian Society of Gastroenterology (SIGE) et al (2010) Cholangiocarcinoma: a position paper by the Italian Society of Gastroenterology (SIGE), the Italian Association of Hospital Gastroenterology (AIGO), the Italian Association of Medical Oncology (AIOM) and the Italian Association of Oncological Radiotherapy (AIRO). Dig Liver Dis 42(12):831–838CrossRefGoogle Scholar
- 23.Ohtsuka M, Kimura F, Shimizu H, Yoshidome H, Kato A, Yoshitomi H et al (2009) Significance of repeated resection for recurrent intrahepatic cholangiocarcinoma. Hepatogastroenterology 56(89):1–5Google Scholar
- 25.Primrose JN, Fox R, Palmer DH, Prasad R, Mirza D, Anthoney DA, et al (2017) Adjuvant capecitabine for biliary tract cancer: The BILCAP randomized study. ASCO 2017; Abstract 4006Google Scholar