Survival Benefits of Surgical Resection in Patients with Recurrent Biliary Tract Carcinoma

Motoyama, Hiroaki; Kobayashi, Adam; Yokoyama, Tetsuji; Shimizu, Akira; Kitagawa, Noriyuki; Noguchi, Tsuyoshi; Fukushima, Kentaro; Masuo, Hitoshi; Yoshizawa, Takahiro; Miyagawa, Shinichi

doi:10.1007/s00268-017-4107-3

Cited by 6 publications

(10 citation statements)

References 59 publications

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“…In an observational study, 5‐year survival rates were 45% for 13 cases of hepatectomy for metachronous liver metastases from biliary tract cancer and 0% for nine cases of unresectable liver metastases 17 . Motoyama et al also reported 5‐year OS rates of 40% after hepatectomy in 15 patients and 7% in 16 patients who had chemotherapy alone and concluded that hepatectomy can improve the prognosis in selected patients 18 . All of these are retrospective, case‐observation studies, and a strong selection bias is likely involved; nevertheless, hepatectomy might be effective treatment for highly selected patients with metachronous liver metastases from biliary tract cancer who fulfill certain strict criteria.…”

Section: Resultsmentioning

confidence: 99%

“…Hepatectomy for liver metastases from these primaries cannot be recommended even if an R0 resection is achievable. There may be a few exceptions, such as three or fewer metachronous tumors smaller than 3‐5 cm developing >2 years after the resection of the primary site 15–18 …”

Section: Resultsmentioning

confidence: 99%

“…Although it is difficult to provide definitive evidence about who is eligible for resection, Sano et al reported that three or fewer metastases of <3 cm diameter each and a potentially R0/1 resection are independent prognostic factors for a better outcome 3 . Others have reported that patients with solitary liver metastases 18 and those in whom the metachronous liver recurrence occurred more than 2 years after resection of the biliary primary have a better prognosis 140 . There is still no evidence regarding the benefit of liver resection for synchronous liver metastases from biliary tract cancer.…”

Section: Resultsmentioning

confidence: 99%

“…There may be a few exceptions, such as three or fewer metachronous tumors smaller than 3-5 cm developing >2 years after the resection of the primary site. [15][16][17][18] Group E comprises breast cancer (clinical question 11) and pancreatic cancer (clinical question 10). Isolated hepatic metastases are extremely rare, and hepatectomy is recommended against except for very rare situations: e.g., situations in which liver metastases develop years after the resection of the primary cancer, an R0 resection is possible, there are no extrahepatic metastases, and concomitant systemic chemotherapy appears to be effective, or in highly controlled experimental trials.…”

Section: Flowchartmentioning

confidence: 99%

“…17 Motoyama et al also reported 5-year OS rates of 40% after hepatectomy in 15 patients and 7% in 16 patients who had chemotherapy alone and concluded that hepatectomy can improve the prognosis in selected patients. 18 All of these are retrospective, case-observation studies, and a strong selection bias is likely involved; nevertheless, hepatectomy might be effective treatment for highly selected patients with metachronous liver metastases from biliary tract cancer who fulfill certain strict criteria. Although it is difficult to provide definitive evidence about who is eligible for resection, Sano et al reported that three or fewer metastases of <3 cm diameter each and a potentially R0/1 resection are independent prognostic factors for a better outcome.…”

Section: Recommendationmentioning

confidence: 99%

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Clinical practice guidelines for the management of liver metastases from extrahepatic primary cancers 2021

Yamamoto

Yoshida

Furuse

et al. 2020

J Hepato Biliary Pancreat

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Background Hepatectomy is standard treatment for colorectal liver metastases; however, it is unclear whether liver metastases from other primary cancers should be resected or not. The Japanese Society of Hepato‐Biliary‐Pancreatic Surgery therefore created clinical practice guidelines for the management of metastatic liver tumors. Methods Eight primary diseases were selected based on the number of hepatectomies performed for each malignancy per year. Clinical questions were structured in the population, intervention, comparison, and outcomes (PICO) format. Systematic reviews were performed, and the strength of recommendations and the level of quality of evidence for each clinical question were discussed and determined. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations. Results The eight primary sites were grouped into five categories based on suggested indications for hepatectomy and consensus of the guidelines committee. Fourteen clinical questions were devised, covering five topics: (1) diagnosis, (2) operative treatment, (3) ablation therapy, (4) the eight primary diseases, and (5) systemic therapies. The grade of recommendation was strong for one clinical question and weak for the other 13 clinical questions. The quality of the evidence was moderate for two questions, low for 10, and very low for two. A flowchart was made to summarize the outcomes of the guidelines for the indications of hepatectomy and systemic therapy. Conclusions These guidelines were developed to provide useful information based on evidence in the published literature for the clinical management of liver metastases, and they could be helpful for conducting future clinical trials to provide higher‐quality evidence.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Flowchartmentioning

confidence: 99%

Section: Recommendationmentioning

confidence: 99%

See 3 more Smart Citations

Clinical practice guidelines for the management of liver metastases from extrahepatic primary cancers 2021

Yamamoto

Yoshida

Furuse

et al. 2020

J Hepato Biliary Pancreat

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Effect of local treatment in patients with oligo‐recurrence after surgery of distal bile duct cancer: A bi‐institutional study

et al. 2023

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Background: Distal extrahepatic bile duct (EHBD) cancer is highly recurrent.More than 50% of patients suffer from disease relapse after curative resection. Some patients present with oligo-recurrence which could be a single loco-regional mass or lesions limited to a single solid organ. The aim of this study was to examine the effect of local control (surgical resection or radiofrequency ablation) on survival outcomes in patients with oligo-recurrent distal EHBD cancer. Methods: Data of 1219 patients who underwent surgery for distal EHBD cancer from 2000 to 2018 were retrospectively reviewed. Clinicopathological characteristics and survival outcomes of patients with recurrence were investigated. Postrecurrence survival (PRS) was analyzed according to modalities of re-treatment (local treatment or systemic therapy alone).Results: Among 654 patients with recurrence, 90 patients who had oligo-recurrence showed better recurrence-free and overall survival than patients with non-oligorecurrent disease. Lymph node ratio and perineural invasion at initial pathology, timing of recurrence, and platelet-to-lymphocyte ratio at recurrence were independent risk factors for PRS in the oligo-recurrent group. Patients with local treatment for oligorecurrence had better 3-and 5-year PRS than those with systemic treatment alone (38.3% vs. 14.1%, p = 0.04; 28.3% vs. 7.1%, p = 0.04, respectively). Recurrence within 24 months after initial surgery was the only significant factor for PRS in the local treatment group. Conclusion:In patients with oligo-recurrence after resection of distal EHBD cancer, post-recurrence local treatment could improve survival outcomes, particularly for those with recurrence more than 2 years after initial resection.

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Long-Term Survivor of Intrahepatic Cholangiocarcinoma for over 18 Years: Case Study with Longitudinal Histo-molecular and Tumor Immune Microenvironment Characterization and Systematic Review of the Literature

Mattiolo,

De Bellis,

Mafficini

et al. 2024

J Gastrointest Canc

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Background Intrahepatic cholangiocarcinoma is a biliary neoplasm usually showing a dismal prognosis. In early stages, surgical resection is the best treatment option, significantly increasing the overall survival. This approach is also recommended in the case of relapsing disease. In this study, we report the case of a patient affected by intrahepatic cholangiocarcinoma with multiple relapses and still alive for over 18 years. We also provide a systematic review regarding long-survivor (> 60 months) of intrahepatic cholangiocarcinoma. Case Presentation A 41-year-old woman with no pathological history was diagnosed with localized intrahepatic cholangiocarcinoma and surgically treated with left hepatectomy. After the first intervention, the patients underwent three further surgical resections because of locoregional recurrences. Histologically, there were some significant similarities among all neoplasms, including the tubule-glandular architecture, but also morphological heterogeneity. The tumor immune microenvironment remained stable across the different lesions. The molecular analysis with next-generation sequencing demonstrated that all neoplasms shared the same genomic profile, including NBN and NOTCH3 mutations and chromosomes 1 and 3 alterations. Conclusions This case study highlights the essential role of a stringent follow-up after resection of intrahepatic cholangiocarcinoma for detecting early relapsing tumors. Moreover, it shows the importance of the molecular characterization of multiple tumors for understanding their real nature. The accurate study of long-surviving patients highlights the features that are critical for outcome improvement.

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Survival Benefits of Surgical Resection in Patients with Recurrent Biliary Tract Carcinoma

Abstract: Surgical resection for recurrent BTC may prolong survival in highly selected patients. A hepatectomy might offer a survival benefit for patients with a solitary liver metastasis.

Cited by 6 publications

References 59 publications

Clinical practice guidelines for the management of liver metastases from extrahepatic primary cancers 2021

Clinical practice guidelines for the management of liver metastases from extrahepatic primary cancers 2021

Effect of local treatment in patients with oligo‐recurrence after surgery of distal bile duct cancer: A bi‐institutional study

Long-Term Survivor of Intrahepatic Cholangiocarcinoma for over 18 Years: Case Study with Longitudinal Histo-molecular and Tumor Immune Microenvironment Characterization and Systematic Review of the Literature

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