Recurrence Rate and Pattern of Perihilar Cholangiocarcinoma after Curative Intent Resection

Abstract

Background To investigate the rate and pattern of recurrence after curative intent resection of perihilar cholangiocarcinoma (PHC). Study design Patients were included from two prospectively maintained databases. Recurrences were categorized by site. Time to recurrence and recurrence free survival (RFS) were estimated using the Kaplan-Meier method. Cox proportional hazards modeling was used to identify independent poor prognostic factors. Results Between 1991 and 2012, 306 consecutive patients met the inclusion criteria. The median overall survival was 40 months. A recurrence was diagnosed in 177 patients (58%). An initial local recurrence was found in 26% of patients: liver hilum (11%), hepaticojejunostomy (8%), liver resection margin (8%), or distal bile duct remnant (2%). An initial distant recurrence was observed in 40% of patients: retroperitoneal lymph nodes (14%), intrahepatic away from the resection margin (13%), peritoneum (12%), and lungs (8%). Only 18% of patients had an isolated initial local recurrence. The estimated overall recurrence rate was 76% at 8 years. After a recurrence free period of 5 years, 28% of patients developed a recurrence in the next 3 years. Median RFS was 26 months. Independent prognostic factors for RFS were resection margin, lymph node status, and tumor differentiation. Only node-positive PHC precluded RFS beyond 7 years. Conclusions PHC will recur in most patients (76%) after resection, emphasizing the need for better adjuvant strategies. The high recurrence rate up to eight years justifies prolonged surveillance. Only patients with an isolated initial local recurrence (18%) may have benefited from a more extensive resection or liver transplantation. Node-positive PHC appears incurable.

Survival after resection of perihilar cholangiocarcinoma in patients with lymph node metastases

“…(2, 13, 14) In a recent study conducted in a large international cohort, patients with lymph node metastases had an estimated 100% chance of recurrence. (15) However, resection of LN+ PHC may still improve life expectancy. The aim of this multi-institutional study was to compare survival of patients with PHC with LN+ who underwent a resection with patients who did not undergo resection because of locally advanced disease at exploratory laparotomy.…”

Impact of adjuvant chemoradiation on survival in patients with resectable cholangiocarcinoma

“…[1][2][3][4][5][6][7][8] Among the minority of patients whose presentation is amenable to curative resection, local recurrence is the rule not the exception. 1,[9][10][11] While the only curative treatment for CC patients remains surgical resection, post-operative outcomes have shown no significant improvements in the past several years 11 with the current five-year survival rate stagnating at a mere 5% for all CC patients. 12 Due to a historically low incidence in Western countries in addition to a low proportion of resectable disease at presentation, there are few established criteria for the treatment of CC in the post-operative setting.…”

Clinical implication of surgical resection for recurrent biliary tract cancer: Does it work or not?

“…However, the prognosis after surgical resection for bile duct cancer still remains unsatisfactory. Reported survival rates range from 24% to 40% 34, 35, 36. Recurrent biliary tract cancer usually manifests as local failure, liver metastasis, lymph nodes metastasis and peritoneal metastasis.…”