Fabian Bartsch1, Johannes Eberhard2, Felix Rückert2, Moritz Schmelzle3, Nadja Lehwald-Tywuschik4, Stefan Fichtner-Feigl5, Jochen Gaedcke6, Karl J Oldhafer7, Felix Oldhafer8, Markus Diener9, Arianeb Mehrabi9, Utz Settmacher10, Thomas Becker11, Tobias Keck12, Helmut Friess13, Benjamin Strücker14, Sabine Opitz15, Johannes Lemke16, Andreas Schnitzbauer17, Hauke Lang1. 1. Department of General, Visceral and Transplant Surgery - University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany. 2. Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. 3. Department of Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany. 4. Department of Surgery, University Hospital Düsseldorf, Düsseldorf, Germany. 5. Department of General and Visceral Surgery, Medical Center, University of Freiburg, Freiburg, Germany. 6. Department of General, Visceral, and Pediatric Surgery, University Medical Center Goettingen, Goettingen, Germany. 7. Division of Hepatopancreatobiliary (HPB) Surgery, Department of Surgery, Asklepios Hospital Barmbek, Semmelweis University, Hamburg, Germany. 8. Department of General, Visceral and Transplant Surgery, Medizinische Hochschule Hannover, Hannover, Germany. 9. Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany. 10. Clinic for General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany. 11. Department for General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, University Hospital Schleswig Holstein, Kiel, Germany. 12. Department of Surgery, University Medical Center Schleswig-Holstein, Luebeck, Germany. 13. Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. 14. Department of General, Visceral and Transplantation Surgery, Universitätsklinikum Münster, Münster, Germany. 15. Department of Surgery, Regensburg University Medical Center, Regensburg, Germany. 16. Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany. 17. Department of General and Visceral Surgery, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt/Main, Germany.
Abstract
BACKGROUND: Tumour recurrence is common after resection of intrahepatic cholangiocarcinoma (ICC). Repeated resection is a potential curative treatment, but outcomes are not well-defined thus far. The aim of this retrospective multicentre cohort study was to show the feasibility and survival of repeated resection of ICC recurrence. METHODS: Data were collected from 18 German hepato-pancreatico-biliary centres for patients who underwent repeated exploration of recurrent ICC between January 2008 and December 2017. Primary end points were overall (OS) and recurrence-free survival from the day of primary and repeated resection. RESULTS: Of 156 patients who underwent repeated exploration for recurrent ICC, 113 underwent re-resection. CA19-9 prior to primary resection, R status of first liver resection and median time to recurrence were significant determinants of repeated resectability. Median OS in the repeated resection group was 65.2 months, with consecutive 1-, 3- and 5-year OS of 98%, 78% and 57% respectively. After re-exploration, median OS from primary resection was 46.7 months, with a consecutive 1-, 3- and 5-year OS of 95%, 55% and 22% respectively. From the day of repeated resection, the median OS was 36.8 months, with a consecutive 1-, 3- and 5-year OS of 86%, 51% and 34% respectively. Minor morbidity (grade I+II) was present in 27%, grade IIIa-IVb morbidity in 20% and mortality in 3.5% of patients. CONCLUSION: Repeated resection of ICC has acceptable morbidity and mortality and seems to be associated with improved long-term survival. Structured follow-up after resection of ICC is necessary for early identification of these patients.
BACKGROUND: Tumour recurrence is common after resection of intrahepatic cholangiocarcinoma (ICC). Repeated resection is a potential curative treatment, but outcomes are not well-defined thus far. The aim of this retrospective multicentre cohort study was to show the feasibility and survival of repeated resection of ICC recurrence. METHODS: Data were collected from 18 German hepato-pancreatico-biliary centres for patients who underwent repeated exploration of recurrent ICC between January 2008 and December 2017. Primary end points were overall (OS) and recurrence-free survival from the day of primary and repeated resection. RESULTS: Of 156 patients who underwent repeated exploration for recurrent ICC, 113 underwent re-resection. CA19-9 prior to primary resection, R status of first liver resection and median time to recurrence were significant determinants of repeated resectability. Median OS in the repeated resection group was 65.2 months, with consecutive 1-, 3- and 5-year OS of 98%, 78% and 57% respectively. After re-exploration, median OS from primary resection was 46.7 months, with a consecutive 1-, 3- and 5-year OS of 95%, 55% and 22% respectively. From the day of repeated resection, the median OS was 36.8 months, with a consecutive 1-, 3- and 5-year OS of 86%, 51% and 34% respectively. Minor morbidity (grade I+II) was present in 27%, grade IIIa-IVb morbidity in 20% and mortality in 3.5% of patients. CONCLUSION: Repeated resection of ICC has acceptable morbidity and mortality and seems to be associated with improved long-term survival. Structured follow-up after resection of ICC is necessary for early identification of these patients.