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.
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.
Authors: W R Jarnagin; Y Fong; R P DeMatteo; M Gonen; E C Burke; J Bodniewicz BS; M Youssef BA; D Klimstra; L H Blumgart Journal: Ann Surg Date: 2001-10 Impact factor: 12.969
Authors: T M van Gulik; J J Kloek; A T Ruys; O R C Busch; G J van Tienhoven; J S Lameris; E A J Rauws; D J Gouma Journal: Eur J Surg Oncol Date: 2010-11-27 Impact factor: 4.424
Authors: Kaori Ito; Hiromichi Ito; Peter J Allen; Mithat Gonen; David Klimstra; Michael I D'Angelica; Yuman Fong; Ronald P DeMatteo; Murray F Brennan; Leslie H Blumgart; William R Jarnagin Journal: Ann Surg Date: 2010-04 Impact factor: 12.969
Authors: M F Gerhards; D G Gonzalez; H ten Hoopen-Neumann; T M van Gulik; L T de Wit; D J Gouma Journal: Eur J Surg Oncol Date: 2000-08 Impact factor: 4.424
Authors: Gennaro Nuzzo; Felice Giuliante; Francesco Ardito; Ivo Giovannini; Luca Aldrighetti; Giulio Belli; Fabrizio Bresadola; Fulvio Calise; Raffaele Dalla Valle; Davide F D'Amico; Leandro Gennari; Stefano M Giulini; Alfredo Guglielmi; Elio Jovine; Riccardo Pellicci; Heinrich Pernthaler; Antonio D Pinna; Stefano Puleo; Guido Torzilli; Lorenzo Capussotti; Umberto Cillo; Giorgio Ercolani; Massimo Ferrucci; Laura Mastrangelo; Nazario Portolani; Carlo Pulitanò; Dario Ribero; Andrea Ruzzenente; Vincenzo Scuderi; Bruno Federico Journal: Arch Surg Date: 2012-01
Authors: Sung Gyu Lee; Gi Won Song; Shin Hwang; Tae Yong Ha; Deok Bog Moon; Dong Hwan Jung; Ki Hun Kim; Chul Soo Ahn; Myung Hwan Kim; Sung Koo Lee; Kyu Bo Sung; Gi Young Ko Journal: J Hepatobiliary Pancreat Sci Date: 2009-10-23 Impact factor: 7.027
Authors: Jesus M Banales; Jose J G Marin; Angela Lamarca; Pedro M Rodrigues; Shahid A Khan; Lewis R Roberts; Vincenzo Cardinale; Guido Carpino; Jesper B Andersen; Chiara Braconi; Diego F Calvisi; Maria J Perugorria; Luca Fabris; Luke Boulter; Rocio I R Macias; Eugenio Gaudio; Domenico Alvaro; Sergio A Gradilone; Mario Strazzabosco; Marco Marzioni; Cédric Coulouarn; Laura Fouassier; Chiara Raggi; Pietro Invernizzi; Joachim C Mertens; Anja Moncsek; Sumera Rizvi; Julie Heimbach; Bas Groot Koerkamp; Jordi Bruix; Alejandro Forner; John Bridgewater; Juan W Valle; Gregory J Gores Journal: Nat Rev Gastroenterol Hepatol Date: 2020-06-30 Impact factor: 46.802
Authors: Laura L Dover; Robert A Oster; Andrew M McDonald; Derek A DuBay; Thomas N Wang; Rojymon Jacob Journal: HPB (Oxford) Date: 2016-08-16 Impact factor: 3.647
Authors: Víctor Molina; Jaime Sampson; Joana Ferrer; Alba Díaz; Juan Ramon Ayuso; Santiago Sánchez-Cabús; Josep Fuster; Juan Carlos García-Valdecasas Journal: Langenbecks Arch Surg Date: 2016-12-23 Impact factor: 3.445
Authors: Stefan Buettner; Jeroen L A van Vugt; Marcia P Gaspersz; Robert J S Coelen; Eva Roos; Tim A Labeur; Georgios A Margonis; Cecilia G Ethun; Shishir K Maithel; George Poultsides; Thuy Tran; Kamran Idrees; Chelsea A Isom; Ryan C Fields; Bradley A Krasnick; Sharon M Weber; Ahmed Salem; Robert C G Martin; Charles R Scoggins; Perry Shen; Harveshp D Mogal; Carl Schmidt; Eliza Beal; Ioannis Hatzaras; Rivfka Shenoy; Jan N M IJzermans; Thomas M van Gulik; Timothy M Pawlik; Bas Groot Koerkamp Journal: HPB (Oxford) Date: 2017-05-23 Impact factor: 3.647
Authors: Cecilia G Ethun; Alexandra G Lopez-Aguiar; Douglas J Anderson; Andrew B Adams; Ryan C Fields; Maria B Doyle; William C Chapman; Bradley A Krasnick; Sharon M Weber; Joshua D Mezrich; Ahmed Salem; Timothy M Pawlik; George Poultsides; Thuy B Tran; Kamran Idrees; Chelsea A Isom; Robert C G Martin; Charles R Scoggins; Perry Shen; Harveshp D Mogal; Carl Schmidt; Eliza Beal; Ioannis Hatzaras; Rivfka Shenoy; Kenneth Cardona; Shishir K Maithel Journal: Ann Surg Date: 2018-05 Impact factor: 12.969