Effectiveness of repeat surgery for recurrence after primary hepatectomy in patients with intrahepatic cholangiocarcinoma

Tokuda, Kazunori; Morine, Yuji; Saito, Yu; Yamada, Shinichiro; Miyazaki, Katsuki; Yamashita, Shoko; Okikawa, Shohei; Ikemoto, Tetsuya; Imura, Satoru

doi:10.1007/s10147-020-01775-x

Cited by 5 publications

(3 citation statements)

References 25 publications

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“…They stated that the indication for surgery in patients with multiple metastases should be carefully determined [13]. In the case of recurrent resection of intrahepatic cholangiocarcinoma, it has been reported that the prognosis is good for single lesions [17]. It has also been reported that patients with intrahepatic metastases at the time of initial surgery have a poor prognosis and should not be considered for resection of recurrent lesions [27].…”

Section: Discussionmentioning

confidence: 99%

Indications for resection of recurrent lesions in patients with distal cholangiocarcinoma based on prognostic factors: A single-institute retrospective study and brief literature review

Mashiko

Ogasawara

Masuoka

et al. 2022

Preprint

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Background To evaluate the effectiveness of surgery for recurrent distal cholangiocarcinoma and determine surgical indications based on prognostic factors of primary and recurrent distal cholangiocarcinoma. Methods We analysed the outcomes of 101 patients who underwent surgical resection for distal cholangiocarcinoma during 2000–2018 and investigated the clinicopathological factors and prognosis of primary and recurrent distal cholangiocarcinoma. Results Of the 101 patients with resected distal cholangiocarcinoma, 52 (51.5%) had relapsed. Seven (13.5%) and 45 patients (86.5%) underwent resection of recurrent lesions and palliative therapy, respectively. There were no major complications requiring therapeutic intervention after metastasectomy. The median overall survival in patients with and without surgery for recurrent lesions was 83.0 (0.0–185.6) and 34 months (19.0–49.0), respectively. Therefore, patients who had undergone surgery for recurrent lesions had a significantly better prognosis (p = 0.022). Multivariate analyses of primary distal cholangiocarcinoma revealed that positive lymph node metastasis, positive portal vein invasion, and recurrence within one year were independent predictors of poor survival. Multivariate analyses of recurrent distal cholangiocarcinoma revealed that recurrence within one year were independent predictors of poor survival. Resection of recurrent lesions improved prognosis. Conclusions Radical resection in recurrent distal cholangiocarcinoma may improve the prognosis in selected patients. In particular, patients with negative lymph node metastases, negative portal vein invasion at the time of the first surgery, and where recurrence is more than a year are considered good candidates for metastasectomy.

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Section: Discussionmentioning

confidence: 99%

Indications for resection of recurrent lesions in patients with distal cholangiocarcinoma based on prognostic factors: A single-institute retrospective study and brief literature review

Mashiko

Ogasawara

Masuoka

et al. 2022

Preprint

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“…However, since the prognoses and prognostic factors of intrahepatic cholangiocarcinoma, hilar cholangiocarcinoma, distal cholangiocarcinoma, and gallbladder cancer are slightly different, we thought it would be better to consider them separately, since their biological behaviours are different [ 8 ]. Most reports on this topic concern the recurrent resection of all biliary tract cancers or repeat liver resection of intrahepatic cholangiocarcinoma [ 9 – 13 , 21 , 22 ]. In this study, we focused on DCC as there are few reports on the resection of recurrent lesions in DCC alone.…”

Section: Discussionmentioning

confidence: 99%

Indications for resection of recurrent lesions in patients with distal cholangiocarcinoma based on prognostic factors: a single-institute retrospective study and brief literature review

et al. 2022

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Background To evaluate the effectiveness of surgery for recurrent distal cholangiocarcinoma and determine surgical indications based on prognostic factors for the recurrence of distal cholangiocarcinoma. Methods We analysed the outcomes of 101 patients who underwent surgical resection for distal cholangiocarcinoma between 2000 and 2018. The clinicopathological factors and prognosis of primary and recurrent distal cholangiocarcinoma were investigated. Results Of the 101 patients with resected distal cholangiocarcinoma, 52 (51.5%) had relapsed. Seven (13.5%) and 45 patients (86.5%) underwent resection of recurrent lesions and palliative therapy, respectively. There were no major complications requiring therapeutic intervention after metastasectomy. The median overall survival in patients with and without surgery for recurrent lesions was 83.0 (0.0–185.6) and 34 months (19.0–49.0), respectively. Therefore, patients who had undergone surgery for recurrent lesions had a significantly better prognosis (p = 0.022). Multivariate analyses of recurrent distal cholangiocarcinoma revealed that recurrence within one year was an independent predictor of poor survival. Resection of recurrent lesions improved prognosis. Conclusions Radical resection in recurrent distal cholangiocarcinoma may improve the prognosis in selected patients. Although time to recurrence is considered an important factor, the small number of cases of recurrence and resection of recurrent lesions in this study makes it difficult to conclude which patients are best suited for resection of recurrent lesions. This issue requires clarification in a multicentre prospective study, considering patients’ background, such as the recurrence site and number of metastases.

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“…Surgical resection remains the only potential therapy that can cure ICC patients ( 3 , 4 ). However, only 20–40% of patients present with resectable disease at the time of diagnosis, and even in this subset of patients undergoing liver resection, recurrence is a common event with a poor 5- year survival of 30–35% ( 5 ). An accurate staging protocol is essential for prognostic stratification and determining treatment strategy.…”

Section: Introductionmentioning

confidence: 99%

Proposal for a new N-stage classification system for intrahepatic cholangiocarcinoma

Liao,

et al. 2023

Front. Oncol.

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BackgroundThe number of metastatic lymph nodes (MLNs) is not considered in the nodal status (N classification) of intrahepatic cholangiocarcinoma (ICC) in the current 8thEdition of the American Joint Committee on Cancer (AJCC) staging system. The aim of this study was to find out the optimal cut-off point based on the number of MLNs and establish a modified AJCC staging system for ICC according to the new N categoryMethodsA total of 675 ICC patients diagnosed between 2004 and 2015 were retrieved from the Surveillance, Epidemiology and End Results (SEER) database. The optimal cut-off value of MLNs affecting survival was determined by X-tile software. The relative discriminative power was assessed by Harrell’s concordance index (C-index) and Akaike information criterion (AIC).ResultsThe proposed new nodal category subdivided patients into three groups (N0, no MLN; N1, 1–3 MLNs; and N2, ≥ 4 MLNs) with significantly different overall survival (P < 0.001). Multivariable analysis revealed that the new nodal category was an independent prognostic factor (P < 0.001). Both the C-index and AIC for our modified staging system were better than those for the 8th AJCC edition (0.574 [95% confidence interval 0.533-0.615] versus 0.570 [95% confidence interval 0.527-0.613], and 853.30 versus 854.21, respectively).ConclusionThe modified AJCC staging system based on the number of MLNs may prove to be a useful alternative for predicting survival of ICC patients in clinical practice.

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Effectiveness of repeat surgery for recurrence after primary hepatectomy in patients with intrahepatic cholangiocarcinoma

Cited by 5 publications

References 25 publications

Indications for resection of recurrent lesions in patients with distal cholangiocarcinoma based on prognostic factors: A single-institute retrospective study and brief literature review

Indications for resection of recurrent lesions in patients with distal cholangiocarcinoma based on prognostic factors: A single-institute retrospective study and brief literature review

Indications for resection of recurrent lesions in patients with distal cholangiocarcinoma based on prognostic factors: a single-institute retrospective study and brief literature review

Proposal for a new N-stage classification system for intrahepatic cholangiocarcinoma

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