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

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

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.

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Acknowledgments

The authors thank Donielle Neal, Susana Rodrigues, John Miura, Francesca Ratti, Timothy Newhook, Malcolm H. Squires, and Stéphanie Meyer.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Gaya Spolverato MD, Yuhree Kim MD, MPH & Timothy M. Pawlik MD, MPH, PhD

  2. Fundeni Clinical Institute, Bucharest, Romania

    Sorin Alexandrescu MD

  3. Curry Cabral Hospital, Lisbon, Portugal

    Hugo P. Marques MD & Jorge Lamelas MD

  4. Ospedale San Raffaele, Milan, Italy

    Luca Aldrighetti MD

  5. Medical College of Wisconsin, Milwaukee, WI, USA

    T. Clark Gamblin MD

  6. Emory University, Atlanta, GA, USA

    Shishir K. Maithel MD

  7. University of Sydney, Sydney, Australia

    Carlo Pulitano MD

  8. University of Virginia, Charlottesville, VA, USA

    Todd W. Bauer MD

  9. Eastern Hepatobiliary Surgery Hospital, Shanghai, China

    Feng Shen MD

  10. Stanford University, Stanford, CA, USA

    George A. Poultsides MD & Thuy B. Tran MD

  11. University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    J. Wallis Marsh MD

  12. Division of Surgical Oncology, John L. Cameron Professor of Alimentary Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA

    Timothy M. Pawlik MD, MPH, PhD

Authors
  1. Gaya Spolverato MD
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  2. Yuhree Kim MD, MPH
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  3. Sorin Alexandrescu MD
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  4. Hugo P. Marques MD
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  9. Carlo Pulitano MD
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  10. Todd W. Bauer MD
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  11. Feng Shen MD
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  12. George A. Poultsides MD
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  13. Thuy B. Tran MD
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  14. J. Wallis Marsh MD
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  15. Timothy M. Pawlik MD, MPH, PhD
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Corresponding author

Correspondence to Timothy M. Pawlik MD, MPH, PhD.

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Spolverato, G., Kim, Y., Alexandrescu, S. et al. Management and Outcomes of Patients with Recurrent Intrahepatic Cholangiocarcinoma Following Previous Curative-Intent Surgical Resection. Ann Surg Oncol 23, 235–243 (2016). https://doi.org/10.1245/s10434-015-4642-9

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  • DOI: https://doi.org/10.1245/s10434-015-4642-9

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