OBJECTIVE: To review our experiences with surgery for recurrent biliary tract cancer (BTC). BACKGROUND: Few studies have reported on surgical procedures for recurrent BTC; therefore, it is unclear whether this surgery has survival benefit. METHODS: Between 1991 and 2010, 606 patients had recurrences after resection of BTC (gallbladder cancer, n = 135; cholangiocarcinoma, n = 471); 74 patients underwent resection for recurrence, whereas the remaining 532 did not. The medical records were retrospectively reviewed. RESULTS: Compared with the 532 patients without surgery for recurrence, the 74 patients with surgery had less advanced cancer, and their time to recurrence was significantly longer (1.4 vs 0.8 years; P < 0.001). A total of 89 surgical procedures for recurrence were performed in the 74 patients (1 time in 63 and ≥2 times in 11). Survival after recurrence was significantly better in the 74 patients with surgery than in the 532 without (32% vs 3% at 3 years; P < 0.001). Survival after surgery for recurrence was (1) similar between gallbladder cancer and cholangiocarcinoma; (2) significantly better in patients with initial disease-free interval of 2 or more years; (3) significantly worse in patients with chest or abdominal wall recurrences; and (4) significantly better in patients with pN0 disease in their primary cancer. Nodal status of the primary tumor and the site of initial recurrence were identified as independent prognostic factors after surgery for recurrence. CONCLUSIONS: Surgical resection for recurrent BTC can be performed safely and offers a better chance of long-term survival in selected patients.
OBJECTIVE: To review our experiences with surgery for recurrent biliary tract cancer (BTC). BACKGROUND: Few studies have reported on surgical procedures for recurrent BTC; therefore, it is unclear whether this surgery has survival benefit. METHODS: Between 1991 and 2010, 606 patients had recurrences after resection of BTC (gallbladder cancer, n = 135; cholangiocarcinoma, n = 471); 74 patients underwent resection for recurrence, whereas the remaining 532 did not. The medical records were retrospectively reviewed. RESULTS: Compared with the 532 patients without surgery for recurrence, the 74 patients with surgery had less advanced cancer, and their time to recurrence was significantly longer (1.4 vs 0.8 years; P < 0.001). A total of 89 surgical procedures for recurrence were performed in the 74 patients (1 time in 63 and ≥2 times in 11). Survival after recurrence was significantly better in the 74 patients with surgery than in the 532 without (32% vs 3% at 3 years; P < 0.001). Survival after surgery for recurrence was (1) similar between gallbladder cancer and cholangiocarcinoma; (2) significantly better in patients with initial disease-free interval of 2 or more years; (3) significantly worse in patients with chest or abdominal wall recurrences; and (4) significantly better in patients with pN0 disease in their primary cancer. Nodal status of the primary tumor and the site of initial recurrence were identified as independent prognostic factors after surgery for recurrence. CONCLUSIONS: Surgical resection for recurrent BTC can be performed safely and offers a better chance of long-term survival in selected patients.
Authors: Alexandre Doussot; Mithat Gonen; Jimme K Wiggers; Bas Groot-Koerkamp; Ronald P DeMatteo; David Fuks; Peter J Allen; Olivier Farges; T Peter Kingham; Jean Marc Regimbeau; Michael I D'Angelica; Daniel Azoulay; William R Jarnagin Journal: J Am Coll Surg Date: 2016-06-11 Impact factor: 6.113