Elsevier

Surgery

Volume 163, Issue 4, April 2018, Pages 732-738
Surgery

Bile Duct/Gall Bladder
Recurrence after curative-intent resection of perihilar cholangiocarcinoma: analysis of a large cohort with a close postoperative follow-up approach

https://doi.org/10.1016/j.surg.2017.08.011Get rights and content

Abstract

Background

Although several studies have been conducted on the patterns of recurrence in resected perihilar cholangiocarcinoma, they have many limitations. The aim of this study was to investigate recurrence after resection and to evaluate prognostic factors on the time to recurrence and recurrence-free survival.

Methods

Consecutive patients who underwent curative-intent resection of perihilar cholangiocarcinoma between 2001 and 2012 were reviewed retrospectively. The Cox proportional hazards model was used for multivariable analysis.

Results

In the study period, 402 patients underwent resection of perihilar cholangiocarcinoma (R0, n = 340; R1, n = 62). Radial margin positivity (n = 43, 69%) was the most common reason for R1 resection. The median follow-up of survivors was 7.4 years. The cumulative recurrence probability was higher in R1 than in R0 resection (86% vs 57% at 5 years, P < .001). Seventeen R0 patients had a recurrence over 5 years after resection. There was no difference in median survival time after recurrence between R0 and R1 resection (10 vs 7 months). The proportion of isolated locoregional recurrence was higher in R1 than in R0 resection (37% vs 16%, P < .001), whereas the proportion of distant recurrence was similar. In R0 resection, the independent prognostic factors for time to recurrence and recurrence-free survival were microscopic venous invasion and lymph node metastasis.

Conclusion

More than half of patients with perihilar cholangiocarcinoma experience recurrence after R0 resection. These recurrences occur frequently within 5 years but occasionally after 5 years, which emphasizes the need for close and long-term surveillance. Adjuvant strategies should be considered, especially for patients with nodal metastasis or venous invasion even after R0 resection.

Section snippets

Patients

Between January 2001 and December 2012, consecutive patients who underwent curative-intent resection of PCC in the First Department of Surgery, Nagoya University Hospital were reviewed retrospectively, with special attention to recurrence patterns. Curative-intent resection was defined as macroscopically complete resection of the tumor. This study was approved by the Human Research Review Committee of Nagoya University Hospital.

Preoperative management

Blood tests including tumor markers (carcinoembryonic antigen and

Results

During the study period, 484 consecutive patients with PCC underwent resection. Of these, 82 were excluded, including 64 patients with pM1 disease, 7 with a R2 resection, 10 (2.1%) who died of postoperative complications, and 1 without detailed follow-up information. The remaining 402 patients, including 251 men and 151 women with a median age of 67 years (range, 34–85 years), were enrolled in the present study.

Of the 402 study patients, 396 (98.5%) underwent hepatectomy with en bloc resection

Discussion

Several studies16, 17, 18, 19, 20, 21, 22 have investigated recurrence after resection of PCC, but they had a number of limitations. First, they all had a small sample size16, 20, 21, 22 and/or included a heterogeneous group of patients, such as those with or without positive surgical margins.17, 18, 19, 20, 21, 22 We considered that the surgical margin status (R status) could affect the patterns of recurrence and RFS; therefore, the present study analyzed the data according to R status.

References (34)

  • H. Kawashima et al.

    Preoperative endoscopic nasobiliary drainage in 164 consecutive patients with suspected perihilar cholangiocarcinoma: a retrospective study of efficacy and risk factors related to complications

    Ann Surg

    (2013)
  • M. Nagino et al.

    Hepatectomy with simultaneous resection of the portal vein and hepatic artery for advanced perihilar cholangiocarcinoma: an audit of 50 consecutive cases

    Ann Surg

    (2010)
  • T. Ebata et al.

    Hepatopancreatoduodenectomy for cholangiocarcinoma: a single-center review of 85 consecutive patients

    Ann Surg

    (2012)
  • S. Miyakawa et al.

    Biliary tract cancer treatment: 5,584 results from the Biliary Tract Cancer Statistics Registry from 1998 to 2004 in Japan

    J Hepatobiliary Pancreat Surg

    (2009)
  • S. Ishihara et al.

    Biliary tract cancer registry in Japan from 2008 to 2013

    J Hepatobiliary Pancreat Sci

    (2016)
  • S.G. Lee et al.

    Surgical treatment of hilar cholangiocarcinoma in the new era: the Asan experience

    J Hepatobiliary Pancreat Sci

    (2010)
  • Y. Seyama et al.

    Long-term outcome of extended hemihepatectomy for hilar bile duct cancer with no mortality and high survival rate

    Ann Surg

    (2003)
  • Cited by (0)

    View full text