Background
Tumor recurrence after liver resection for intrahepatic cholangiocarcinoma is common.
The effective treatment for recurrent intrahepatic cholangiocarcinoma remains to be
established. This study evaluated the short- and long-term prognoses of patients after
repeat hepatic resection for recurrent intrahepatic cholangiocarcinoma.
Methods
Data for 72 patients who underwent R0 repeat hepatic resection for recurrent intrahepatic
cholangiocarcinoma at the Eastern Hepatobiliary Surgery Hospital between 2005 and
2013 were analyzed. Tumor re-recurrence, recurrence-to-death survival, and overall
survival were calculated and compared using the Kaplan-Meier method and the log-rank
test. Independent risk factors were identified by Cox regression analysis.
Results
Operative morbidity and mortality rates were 18.1% and 1.4%, respectively. The 1-,
2-, and 3-year re-recurrence rates were 53.2%, 80.2%, and 92.6%, respectively, and
the corresponding recurrence-to-death survival was 82.9%, 53.0%, and 35.3%, respectively.
The 1-, 3-, and 5-year overall survival was 97.2%, 67.0%, and 41.9%, respectively.
Patients with a time to recurrence of >1 year from the initial hepatectomy achieved
higher 1-, 2-, and 3-year recurrence-to-death survival than patients with a time to
recurrence of ≤1 year (92.5%, 61.7%. and 46.6% vs 70.4%, 42.2%, and 23.0%, P = .022). Multivariate analysis identified that recurrent tumor >3 cm (hazard ratio:
2.346; 95% confidence interval: 1.288–4.274), multiple recurrent nodules (2.304; 1.049–5.059),
cirrhosis (3.165; 1.543–6.491), and a time to recurrence of ≤1 year (1.872; 1.055–3.324)
were independent risk factors of recurrence-to-death survival.
Conclusion
Repeat hepatic resection for recurrent intrahepatic cholangiocarcinoma was safe and
produced long-term survival outcomes in selected patients based on prognostic stratification
with the presence of the independent risk factors of recurrence-to-death survival.
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References
- Epidemiology, risk factors, and pathogenesis of cholangiocarcinoma.HPB (Oxford). 2008; 10: 77-82
- Rising incidence of intrahepatic cholangiocarcinoma in the United States: a true increase?.J Hepatol. 2004; 40: 472-477
- Guidelines for the diagnosis and management of intrahepatic cholangiocarcinoma.J Hepatol. 2014; 60: 1268-1289
- Hepatobiliary cancers, version 2.2014.J Natl Compr Canc Netw. 2014; 12: 1152-1182
- Influence of surgical margins on outcome in patients with intrahepatic cholangiocarcinoma.Ann Surg. 2011; 254: 824-830
- A nomogram to predict long-term survival after resection for intrahepatic cholangiocarcinoma: an Eastern and Western experience.JAMA Surgery. 2014; 149: 432-438
- Intrahepatic cholangiocarcinoma: rising frequency, improved survival, and determinants of outcome after resection.Ann Surg. 2008; 248: 84-96
- The prognosis and survival outcome of intrahepatic cholangiocarcinoma following surgical resection: association of lymph node metastasis and lymph node dissection with survival.Ann Surg Oncol. 2009; 16: 3048-3056
- Recurrence after surgical resection of intrahepatic cholangiocarcinoma.J Hepatobiliary Pancreat Surg. 2001; 8: 154-157
- Hepatic recurrence of cholangiolocellular carcinoma: report of a case.Hepatogastroenterology. 1996; 43: 1046-1050
- Clinicopathological prognostic factors and impact of surgical treatment of mass-forming intrahepatic cholangiocarcinoma.World J Surg. 2002; 26: 687-693
- Repeated hepatectomy for recurrent intrahepatic cholangiocarcinoma: report of two cases.Eur J Gastroenterol Hepatol. 2005; 17: 125-130
- Surgical management of recurrent intrahepatic cholangiocellular carcinoma after liver resection.Surgery. 2005; 137: 669-670
- A case of successful management of repeated recurrent intrahepatic cholangiocarcinoma by repeated hepatectomy and radiofrequency ablations.Gan To Kagaku Ryoho. 2007; 34: 2105-2107
- Fifteen-year, single-center experience with the surgical management of intrahepatic cholangiocarcinoma: operative results and long-term outcome.Surgery. 2008; 143: 366-374
- Recurrence of intrahepatic cholangiocarcinoma nine years after surgical resection.Hepatogastroenterology. 2008; 55: 1085-1088
- Significance of repeated resection for recurrent intrahepatic cholangiocarcinoma.Hepatogastroenterology. 2009; 56: 1-5
- Intrahepatic cholangiocarcinoma: primary liver resection and aggressive multimodal treatment of recurrence significantly prolong survival.Ann Surg. 2010; 252: 107-114
- Recurrent intrahepatic cholangiocarcinoma: single-center experience using repeated hepatectomy and radiofrequency ablation.J Hepatobiliary Pancreat Sci. 2010; 17: 509-515
- Intrahepatic cholangiocarcinoma: analysis of 44 consecutive resected cases including 5 cases with repeat resections.Am J Surg. 2011; 201: 203-208
- A case of intrahepatic recurrence of intrahepatic cholangiocarcinoma treated with repeated hepatectomy.Gan To Kagaku Ryoho. 2011; 38: 2469-2471
- Treatment of recurrent intrahepatic cholangiocarcinoma.Br J Surg. 2012; 99: 1711-1717
- Two cases of long-term survival after treatment of recurrent intrahepatic cholangiocarcinoma and intrahepatic metastasis in the remnant liver with repeated hepatectomy.Gan To Kagaku Ryoho. 2013; 40: 1828-1830
- Recurrence after operative management of intrahepatic cholangiocarcinoma.Surgery. 2013; 153: 811-818
- Thermal ablation versus repeated hepatic resection for recurrent intrahepatic cholangiocarcinoma.Ann Surg Oncol. 2013; 20: 3596-3602
- Re-resection for recurrent intrahepatic cholangiocarcinoma.Gan To Kagaku Ryoho. 2014; 41: 1468-1470
- First and repeat liver resection for primary and recurrent intrahepatic cholangiocarcinoma.Am J Surg. 2016; 212: 221-229
- Management and outcomes of patients with recurrent intrahepatic cholangiocarcinoma following previous curative-intent surgical resection.Ann Surg Oncol. 2016; 23: 235-243
- Surgical treatment for intrahepatic cholangiocarcinoma.Clin J Gastroenterol. 2014; 7: 87-93
- Prognostic nomogram for intrahepatic cholangiocarcinoma after partial hepatectomy.J Clin Oncol. 2013; 31: 1188-1195
- Independent risk factors and predictive score for the development of hepatocellular carcinoma in chronic hepatitis B.J Hepatol. 2009; 50: 80-88
- Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg. 2004; 240: 205-213
- Yttrium-90 radioembolization for unresectable/recurrent intrahepatic cholangiocarcinoma: a survival, efficacy and safety study.Br J Cancer. 2016; 115: 297-302
- Adjuvant chemotherapy with gemcitabine and S-1 after surgical resection for advanced biliary carcinoma: outcomes and prognostic factors.J Hepatobiliary Pancreat Sci. 2012; 19: 306-313
- Different risk factors and prognosis for early and late intrahepatic recurrence after resection of hepatocellular carcinoma.Cancer. 2000; 89: 500-507
- Risk factors contributing to early and late phase intrahepatic recurrence of hepatocellular carcinoma after hepatectomy.J Hepatol. 2003; 38: 200-207
- Expression of insulin-like growth factor II mRNA-binding protein 3 predicts early recurrence and poor prognosis in intrahepatic cholangiocarcinoma.Int J Surg. 2013; 11: 85-91
- Relationship between pancreatic secretory trypsin inhibitor and early recurrence of intrahepatic cholangiocarcinoma following surgical resection.Am J Gastroenterol. 2006; 101: 1601-1610
- The value of systematic lymph node dissection for intrahepatic cholangiocarcinoma from the viewpoint of liver lymphatics.J Gastroenterol. 2015; 50: 913-927
- Extended hepatic resection and outcomes in intrahepatic cholangiocarcinoma.J Hepatobiliary Pancreat Surg. 2003; 10: 259-264
- A long-term survivor of intrahepatic cholangiocarcinoma with paraaortic lymph node metastasis.J Gastroenterol. 2006; 41: 391-392
- Intrahepatic cholangiocarcinoma with lymph node metastasis successfully treated by immunotherapy with CD3-activated T cells and dendritic cells after surgery: report of a case.Surg Today. 2006; 36: 559-562
- Impact of lymph node status in patients with intrahepatic cholangiocarcinoma treated by major hepatectomy: a review of the National Cancer Database.HPB (Oxford). 2016; 18: 79-87
Article info
Publication history
Published online: December 16, 2016
Accepted:
October 18,
2016
Footnotes
Supported by the State Key Project on Infectious Diseases of China (2012ZX10002–016 to FS), the Natural Science Foundation of Shanghai (12ZR1439700 to JL), and the Medical Guiding Project of Shanghai (201346801 to JL). AS and JL contributed equally to this work.
No potential conflicts of interest were disclosed.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
