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Is Repeat Resection for Recurrent Intrahepatic Cholangiocarcinoma Warranted? Outcomes of an International Analysis

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

Abstract

Background

Recurrence of intrahepatic cholangiocarcinoma (ICC) after liver resection (LR) remains high, and optimal therapy for recurrent ICC is challenging. Herein, we assess the outcomes of patients undergoing repeat resection for recurrent ICC in a large, international multicenter cohort.

Patients and Methods

Outcomes of adults from six large hepatobiliary centers in North America, Europe, and Asia with recurrent ICC following primary LR between 2001 and 2015 were analyzed. Cox models determined predictors of post-recurrence survival.

Results

Of patients undergoing LR for ICC, 499 developed recurrence. The median time to recurrence was 10 months, and 47% were intrahepatic. Overall 3-year post-recurrence survival rate was 28.6%. In total, 121 patients (25%) underwent repeat resection, including 74 (61%) repeat LRs. Surgically treated patients were more likely to have solitary intrahepatic recurrences and significantly prolonged survival compared with those receiving locoregional or systemic therapy alone with a 3-year post-recurrence survival rate of 47%. Independent predictors of post-recurrence death included time to recurrence < 1 year [HR 1.66 (1.32–2.10), p < 0.001], site of recurrence [HR 1.74 (1.28–2.38), p < 0.001], macrovascular invasion [HR 1.43 (1.05–1.95), p = 0.024], and size of recurrence > 3 cm [HR 1.68 (1.24–2.29), p = 0.001]. Repeat resection was independently associated with decreased post-recurrence death [HR 0.58 0.43–0.78), p < 0.001].

Conclusions

Repeat resection for recurrent ICC in select patients can result in extended survival. Thus, challenging the paradigm of offering these patients locoregional or chemo/palliative therapy alone as the mainstay of treatment.

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Authors and Affiliations

  1. Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Matthew L. Holzner MD, MSc, Sander Florman MD, Myron E. Schwartz MD & Parissa Tabrizian MD, MSc

  2. Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy

    Vincenzo Mazzaferro MD, PhD & Michele Droz Dit Busset MD

  3. Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy

    Luca Aldrighetti MD, PhD & Francesca Ratti MD

  4. Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Kiyoshi Hasegawa MD, PhD & Junichi Arita MD, PhD

  5. Multi-Organ Transplant and HPB Surgical Oncology, Division of General Surgery, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada

    Gonzalo Sapisochin MD, PhD & Phillipe Abreu MD, PhD

  6. Department of Surgery, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Campus Virchow-Klinikum, Berlin, Germany

    Wenzel Schoning MD, Mortiz Schmelzle MD, Nora Nevermann MD & Johann Pratschke MD

  7. NYU Langone Transplant Institute, NYU Langone Health, New York, NY, USA

    Karim Halazun MD

  8. Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy

    Vincenzo Mazzaferro MD, PhD

Authors
  1. Matthew L. Holzner MD, MSc
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  2. Vincenzo Mazzaferro MD, PhD
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  3. Michele Droz Dit Busset MD
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  4. Luca Aldrighetti MD, PhD
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  5. Francesca Ratti MD
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  6. Kiyoshi Hasegawa MD, PhD
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  7. Junichi Arita MD, PhD
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  8. Gonzalo Sapisochin MD, PhD
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  9. Phillipe Abreu MD, PhD
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  10. Wenzel Schoning MD
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  11. Mortiz Schmelzle MD
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  12. Nora Nevermann MD
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  14. Sander Florman MD
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  15. Karim Halazun MD
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  16. Myron E. Schwartz MD
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  17. Parissa Tabrizian MD, MSc
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Contributions

Tabrizian, Schwartz, and Holzner were responsible for the concept and study design; Holzner, Tabrizian, Mazaferro, Brusset, Ratti, Arita, Sapisochin, Abreu, Schoning, Schmelzle, and Nevermann performed data acquisition, analysis, or interpretation; Holzner and Tabrizian drafted the manuscript; Schwartz, Mazzaferro, Aldrighetti, Hasegawa, Pratschke, Sapisochin, and Florman performed critical revision of the manuscript for important intellectual content; Holzner and Tabrizian performed statistical analysis; and Florman, Halazun, and Schwartz supervised the study.

Corresponding author

Correspondence to Parissa Tabrizian MD, MSc.

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Disclosures

Prof. Moritz Schmelzle has relevant financial activities outside of the submitted work to disclose from Merck Serono GmbH, Bayer AG, ERBE Elektromedizin GmbH, Amgen Inc., AstraZeneca, Avateramedical GmbH, Johnson & Johnson Medical GmbH, Takeda Pharmaceutical Limited, Olympus K.K., Medtronic GmbH, Intuitive Surgical Inc., Corzamedical, and Baxter Int Inc.

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Holzner, M.L., Mazzaferro, V., Busset, M.D.D. et al. Is Repeat Resection for Recurrent Intrahepatic Cholangiocarcinoma Warranted? Outcomes of an International Analysis. Ann Surg Oncol (2024). https://doi.org/10.1245/s10434-024-14975-w

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