Recurrence rate and pattern of perihilar cholangiocarcinoma after curative intent resection Journal Article
| Authors: | Koerkamp, B. G.; Wiggers, J. K.; Allen, P. J.; Besselink, M. G.; Blumgart, L. H.; Busch, O. R. C.; Coelen, R. J.; D'Angelica, M. I.; DeMatteo, R. P.; Gouma, D. J.; Kingham, T. P.; Jarnagin, W. R.; Van Gulik, T. M. |
| Article Title: | Recurrence rate and pattern of perihilar cholangiocarcinoma after curative intent resection |
| Abstract: | BACKGROUND: The aim of this study was to investigate the rate and pattern of recurrence after curative intent resection of perihilar cholangiocarcinoma (PHC). STUDY DESIGN: Patients were included from 2 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 inclusion criteria. 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: Perihilar cholangiocarcinoma will recur in most patients (76%) after resection, emphasizing the need for better adjuvant strategies. The high recurrence rate of up to 8 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. (C) 2015 by the American College of Surgeons. Published by Elsevier Inc. All rights reserved |
| Keywords: | cisplatin; gemcitabine; surgery; outcomes; hilar cholangiocarcinoma; prognostic-factors; surgical-treatment; metaanalysis; resectability; biliary-tract cancer |
| Journal Title: | Journal of the American College of Surgeons |
| Volume: | 221 |
| Issue: | 6 |
| ISSN: | 1072-7515 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2015-12-01 |
| Start Page: | 1041 |
| End Page: | 1049 |
| Language: | English |
| ACCESSION: | WOS:000365346600008 |
| DOI: | 10.1016/j.jamcollsurg.2015.09.005 |
| PROVIDER: | wos |
| PUBMED: | 26454735 |
| PMCID: | PMC4736142 |
| Notes: | Article -- Source: Wos |
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