Management and Outcomes of Patients with Recurrent Intrahepatic Cholangiocarcinoma Following Previous Curative-Intent Surgical Resection

• Published in: Annals of surgical oncology Vol. 23; no. 1; pp. 235 - 243
• Main Authors: Spolverato, Gaya, Kim, Yuhree, Alexandrescu, Sorin, Marques, Hugo P., Lamelas, Jorge, Aldrighetti, Luca, Clark Gamblin, T., Maithel, Shishir K., Pulitano, Carlo, Bauer, Todd W., Shen, Feng, Poultsides, George A., Tran, Thuy B., Wallis Marsh, J., Pawlik, Timothy M.
• Format: Journal Article
• Language: English
• Published: New York Springer US 2016; Springer Nature B.V
• Subjects: Bile Duct Neoplasms - pathology; Bile Duct Neoplasms - surgery; Cholangiocarcinoma - pathology; Cholangiocarcinoma - surgery; Cohort Studies; Disease Management; Follow-Up Studies; Hepatectomy; Hepatobiliary Tumors; Humans; Medicine; Medicine & Public Health; Neoplasm Invasiveness; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - surgery; Neoplasm Staging; Oncology; Prognosis; Surgery; Surgical Oncology; Extrahepatic Disease; Good Supportive Care; Intrahepatic Recurrence; Intrahepatic Cholangiocarcinoma; Hepatic Resection
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-015-4642-9

Background
Management and outcomes of patients with recurrent intrahepatic cholangiocarcinoma (ICC) following curative-intent surgery are not well documented. We sought to characterize the treatment of patients with recurrent ICC and define therapy-specific outcomes.
Methods
Patients who underwent surgery for ICC from 1990 to 2013 were identified from an international database. Data on clinicopathological characteristics, operative details, recurrence, and recurrence-related management were recorded and analyzed.
Results
A total of 563 patients undergoing curative-intent hepatic resection for ICC who met the inclusion criteria were identified. With a median follow-up of 19 months, 400 (71.0 %) patients developed a recurrence. At initial surgery, treatment was resection only (98.8 %) or resection + ablation (1.2 %). Overall 5-year survival was 23.6 %; 400 (71.0 %) patients recurred with a median disease-free survival of 11.2 months. First recurrence site was intrahepatic only (59.8 %), extrahepatic only (14.5 %), or intra- and extrahepatic (25.7 %). Overall, 210 (52.5 %) patients received best supportive care (BSC), whereas 190 (47.5 %) patients received treatment, such as systemic chemotherapy-only (24.2 %) or repeat liver-directed therapy ± systemic chemotherapy (75.8 %). Repeat liver-directed therapy consisted of repeat hepatic resection ± ablation (28.5 %), ablation alone (18.7 %), and intra-arterial therapy (IAT) (52.8 %). Among patients who recurred, median survival from the time of the recurrence was 11.1 months (BSC 8.0 months, systemic chemotherapy-only 16.8 months, liver-directed therapy 18.0 months). The median survival of patients undergoing resection of recurrent ICC was 26.7 months versus 9.6 months for patients who had IAT (
p
< 0.001).
Conclusions
Recurrence following resection of ICC was common, occurring in up to two-thirds of patients. When there is recurrence, prognosis is poor. Only 9 % of patients underwent repeat liver resection after recurrence, which offered a modest survival benefit.