Surgical Resection for Recurrent Intrahepatic Cholangiocarcinoma

Abstract

Background 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. Methods 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 recurrencefree survival. Results 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). Conclusion 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.

Relevance of suspicious lymph nodes in preoperative imaging for resectability, recurrence and survival of intrahepatic cholangiocarcinoma

“…SuspLN did not influence tumor recurrence of any kind in our cohort. This is comprehensible with the pattern of recurrence of ICC, which appears most often intrahepatic with only small amounts of extrahepatic or combined intra-and extrahepatic recurrences [13,32,33].…”

“…Complete resection offers the only chance of cure. The number of negative laparotomies and unresectability is high with resection rates of only 50 to 75% [7,8,12,13]. Long-term outcome is determined by tumor recurrence, which is common in 40-76% of patients [7,14,15].…”

Repeated resection for recurrent intrahepatic cholangiocarcinoma: A retrospective German multicentre study

“…[8][9][10][11] Thus, some smaller series have suggested a survival benefit from repeated hepatectomy, but data are still scarce. [12][13][14][15][16] The aim of this retrospective German multicentre cohort study was to analyse the feasibility and long-term outcome of repeated resection for recurrence of ICC in a large number of patients.…”

A Novel Prognostic Nomogram for Patients With Recurrence of Intrahepatic Cholangiocarcinoma After Initial Surgery

“…Guidelines for the management of recurrent ICC remain controversial and poorly defined. In the routine clinical practice, the therapeutic strategy for recurrence was evaluated based on tumor location, number of tumors, general patient condition, and liver function (20)(21)(22); however, the final choice was influenced by patient factors, including the preference for less invasive treatment and financial considerations decided by our MDT. The treatment allocation for recurrent ICC is recognized as a significant factor in this study.…”

“…The choice of treatment for recurrence was determined from the characteristics of the recurrent tumor, patient preference, and discussion among our multidisciplinary team (MDT) (19)(20)(21). Treatment with curative intent, including surgical re-resection and ablation, was performed in patients with solitary intrahepatic recurrence without a portal vein tumor thrombus, and in patients with an extrahepatic recurrence for which curative treatment was feasible (20)(21)(22). Other treatments were individualized for patients with advanced recurrent disease and included transarterial chemoembolization (TACE), chemotherapy and radiotherapy, depending on disease extent and the patient's performance status.…”