The association between sarcopenic overweight and chemotherapy toxicity in Bile Duct and Gallbladder cancer patients treated with Gemcitabine and Cisplatin

Abstract

Introduction: Tumor recurrence after liver resection (LR) for intrahepatic cholangiocarcinoma (IHC) is common. Repeat liver resection (RLR) for recurrent IHC allows good survival outcomes in selected patients. Aim of the study was to investigate factors affecting the reliability of RLR. Methods: All consecutive first LR for IHC performed between January 2000 and December 2016 were retrospectively reviewed. Data on recurrences were analyzed. Results: In the study period 107 patients underwent first LR for IHC. Major or extended hepatectomies were required in 78(71.8%) cases. Biliary resection was also associated in 22 patients. 90-days mortality was 3.7% (n=4). Ten (9.3%) patients experienced major postoperative complications (Dindo 3e4). IHC gross type was mainly mass-forming(87.8%). Multifocality and satellite nodules were 20.5% and 17.7%. N+ rate was 24.3%. Surgical margin was < 1mm in 11cases. Overall, median survival was 35.3months and 5-year OS 37%. Recurrence occurred in 77patients (74.7%). Sites of relapse were liver-only in 45 patients(42%), extrahepatic in 17(15.8%) and both intra and extrahepatic in 15(14%). Among patients with liver-only recurrence, RLR was performed in 13(28.8%). At multivariate analysis, factors that negatively affected RLR were tumor size >3cm (OR 4.71 CI 1.07-20.6, p=0.040) and previous major resections (PR 26.7 CI 3.12-229, p=0.003) at first treatment. Survival after recurrence was significantly better in patients who underwent RLR compared to untreated patients (40.0 vs 14.0 months, p=0.007). Conclusion: Patients with IHC treated at first resections with major hepatectomy and those with tumor > 3cm had significant lower probability to receive a second resection for liver recurrence.