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Survival Benefits of Surgical Resection in Patients with Recurrent Biliary Tract Carcinoma

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Abstract

Background

Whether surgical resection for recurrent biliary tract carcinoma (BTC) prolongs survival and the patients who are most likely to benefit from such treatment remain unclear.

Methods

Among 251 patients with recurrences after the initial resection of BTC, a total of 21 patients (8.4%) underwent surgical resection for the recurrence, with a zero mortality rate. The clinicopathological features of these patients were compared with those of patients who did not undergo surgery.

Results

The median survival time (MST) after the first recurrence and the 5-year post-recurrent survival (PRS) rate were 19.8 months and 32.8%, respectively, for patients who underwent re-resection. Fourteen patients (66.7%) experienced second recurrences; however, none of these patients underwent further surgical resection. Surgical resection for recurrence was identified as an independent prognostic factor for survival after recurrence (hazard ratio of 0.33, 95% CI of 0.17–0.58, p < 0.001). Patients with less than three liver metastases had a significantly better PRS after surgical resection than after chemotherapy (p = 0.015). Among the patients with an isolated solitary liver metastasis, patients who underwent resection had a significantly longer MST after the first recurrence than patients receiving chemotherapy (22.8 vs. 10.9 months, p = 0.025), whereas the PRS was similar between the two groups among patients with two liver lesions.

Conclusions

Surgical resection for recurrent BTC may prolong survival in highly selected patients. A hepatectomy might offer a survival benefit for patients with a solitary liver metastasis.

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Abbreviations

BTC:

Biliary tract carcinoma

ICC:

Intrahepatic cholangiocarcinoma

PCC:

Perihilar cholangiocarcinoma

DCC:

Distal cholangiocarcinoma

GBC:

Gallbladder carcinoma

CAV:

Carcinomas of the ampulla of Vater

PD:

Pancreaticoduodenectomy

DFI:

Disease-free interval

TNM:

Tumor, node, metastasis

AJCC:

American Joint Committee on Cancer

OS:

Overall survival

MST:

Median survival time

References

  1. Razumilava N, Gores GJ (2014) Cholangiocarcinoma. Lancet 383:2168–2179

    Article  PubMed  PubMed Central  Google Scholar 

  2. Takao S, Shinchi H, Uchikura K et al (1999) Liver metastases after curative resection in patients with distal bile duct cancer. Br J Surg 86:327–331

    Article  CAS  PubMed  Google Scholar 

  3. Todoroki T, Kawamoto T, Koike N et al (2001) Treatment strategy for patients with middle and lower third bile duct cancer. Br J Surg 88:364–370

    Article  CAS  PubMed  Google Scholar 

  4. Kobayashi A, Miwa S, Nakata T et al (2010) Disease recurrence patterns after R0 resection of hilar cholangiocarcinoma. Br J Surg 97:56–64

    Article  CAS  PubMed  Google Scholar 

  5. Gruenberger B, Schueller J, Heubrandtner U et al (2010) Cetuximab, gemcitabine, and oxaliplatin in patients with unresectable advanced or metastatic biliary tract cancer: a phase 2 study. Lancet Oncol 11:1142–1148

    Article  CAS  PubMed  Google Scholar 

  6. Valle J, Wasan H, Palmer DH et al (2010) Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med 362:1273–1281

    Article  CAS  PubMed  Google Scholar 

  7. Lee J, Park SH, Chang HM et al (2012) Gemcitabine and oxaliplatin with or without erlotinib in advanced biliary-tract cancer: a multicentre, open-label, randomised, phase 3 study. Lancet Oncol 13:181–188

    Article  CAS  PubMed  Google Scholar 

  8. Malka D, Cervera P, Foulon S et al (2014) Gemcitabine and oxaliplatin with or without cetuximab in advanced biliary-tract cancer (BINGO): a randomised, open-label, non-comparative phase 2 trial. Lancet Oncol 15:819–828

    Article  CAS  PubMed  Google Scholar 

  9. Eckel F, Schmid RM (2014) Chemotherapy and targeted therapy in advanced biliary tract carcinoma: a pooled analysis of clinical trials. Chemotherapy 60:13–23

    Article  CAS  PubMed  Google Scholar 

  10. Valle JW, Wasan H, Lopes A et al (2015) Cediranib or placebo in combination with cisplatin and gemcitabine chemotherapy for patients with advanced biliary tract cancer (ABC-03): a randomised phase 2 trial. Lancet Oncol 16:967–978

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Yamamoto M, Takasaki K, Otsubo T et al (2001) Recurrence after surgical resection of intrahepatic cholangiocarcinoma. J Hepatobiliary Pancreat Surg 8:154–157

    Article  CAS  PubMed  Google Scholar 

  12. Ohtsuka M, Kimura F, Shimizu H et al (2009) Significance of repeated resection for recurrent intrahepatic cholangiocarcinoma. Hepatogastroenterology 56:1–5

    CAS  PubMed  Google Scholar 

  13. Ercolani G, Vetrone G, Grazi GL et al (2010) Intrahepatic cholangiocarcinoma: primary liver resection and aggressive multimodal treatment of recurrence significantly prolong survival. Ann Surg 252:107–114

    Article  PubMed  Google Scholar 

  14. Kamphues C, Seehofer D, Eisele RM et al (2010) Recurrent intrahepatic cholangiocarcinoma: single-center experience using repeated hepatectomy and radiofrequency ablation. J Hepatobiliary Pancreat Sci 17:509–515

    Article  PubMed  Google Scholar 

  15. Saiura A, Yamamoto J, Kokudo N et al (2011) Intrahepatic cholangiocarcinoma: analysis of 44 consecutive resected cases including 5 cases with repeat resections. Am J Surg 201:203–208

    Article  PubMed  Google Scholar 

  16. Song SC, Heo JS, Choi DW et al (2011) Survival benefits of surgical resection in recurrent cholangiocarcinoma. J Korean Surg Soc 81:187–194

    Article  PubMed  PubMed Central  Google Scholar 

  17. Sulpice L, Rayar M, Boucher E et al (2012) Treatment of recurrent intrahepatic cholangiocarcinoma. Br J Surg 99:1711–1717

    Article  CAS  PubMed  Google Scholar 

  18. Takahashi Y, Ebata T, Yokoyama Y et al (2015) Surgery for recurrent biliary tract cancer: a single-center experience with 74 consecutive resections. Ann Surg 262:121–129

    Article  PubMed  Google Scholar 

  19. Souche R, Addeo P, Oussoultzoglou E et al (2016) First and repeat liver resection for primary and recurrent intrahepatic cholangiocarcinoma. Am J Surg 212:221–229

    Article  PubMed  Google Scholar 

  20. Digestive system. In: Edge SBBD, Compton CC, Fritz AG, Greene FL, Trotti A (ed) AJCC cancer staging manual seventh edition, 7th edn. Springer, New York, pp 201–240 (2010)

  21. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  22. Neoptolemos JP, Moore MJ, Cox TF et al (2012) Effect of adjuvant chemotherapy with fluorouracil plus folinic acid or gemcitabine vs observation on survival in patients with resected periampullary adenocarcinoma: the ESPAC-3 periampullary cancer randomized trial. JAMA 308:147–156

    Article  CAS  PubMed  Google Scholar 

  23. Oettle H, Neuhaus P, Hochhaus A et al (2013) Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial. JAMA 310:1473–1481

    Article  CAS  PubMed  Google Scholar 

  24. Uesaka K, Boku N, Fukutomi A et al (2016) Adjuvant chemotherapy of S-1 versus gemcitabine for resected pancreatic cancer: a phase 3, open-label, randomised, non-inferiority trial (JASPAC 01). Lancet 388:248–257

    Article  CAS  PubMed  Google Scholar 

  25. Weitz J, Blumgart LH, Fong Y et al (2005) Partial hepatectomy for metastases from noncolorectal, nonneuroendocrine carcinoma. Ann Surg 241:269–276

    Article  PubMed  PubMed Central  Google Scholar 

  26. Adam R, Chiche L, Aloia T et al (2006) Hepatic resection for noncolorectal nonendocrine liver metastases: analysis of 1,452 patients and development of a prognostic model. Ann Surg 244:524–535

    Article  PubMed  PubMed Central  Google Scholar 

  27. Earle SA, Perez EA, Gutierrez JC et al (2006) Hepatectomy enables prolonged survival in select patients with isolated noncolorectal liver metastasis. J Am Coll Surg 203:436–446

    Article  PubMed  Google Scholar 

  28. Lendoire J, Moro M, Andriani O et al (2007) Liver resection for non-colorectal, non-neuroendocrine metastases: analysis of a multicenter study from Argentina. HPB (Oxford) 9:435–439

    Article  CAS  Google Scholar 

  29. Reddy SK, Barbas AS, Marroquin CE et al (2007) Resection of noncolorectal nonneuroendocrine liver metastases: a comparative analysis. J Am Coll Surg 204:372–382

    Article  PubMed  Google Scholar 

  30. O’Rourke TR, Tekkis P, Yeung S et al (2008) Long-term results of liver resection for non-colorectal, non-neuroendocrine metastases. Ann Surg Oncol 15:207–218

    Article  PubMed  Google Scholar 

  31. Ercolani G, Vetrone G, Grazi GL et al (2009) The role of liver surgery in the treatment of non-colorectal non-neuroendocrine metastases (NCRNNE). Analysis of 134 resected patients. Minerva Chir 64:551–558

    CAS  PubMed  Google Scholar 

  32. Berney T, Mentha G, Roth AD et al (1998) Results of surgical resection of liver metastases from non-colorectal primaries. Br J Surg 85:1423–1427

    Article  CAS  PubMed  Google Scholar 

  33. Elias D, Cavalcanti de Albuquerque A, Eggenspieler P et al (1998) Resection of liver metastases from a noncolorectal primary: indications and results based on 147 monocentric patients. J Am Coll Surg 187:487–493

    Article  CAS  PubMed  Google Scholar 

  34. Hemming AW, Sielaff TD, Gallinger S et al (2000) Hepatic resection of noncolorectal nonneuroendocrine metastases. Liver Transpl 6:97–101

    Article  CAS  PubMed  Google Scholar 

  35. Laurent C, Rullier E, Feyler A et al (2001) Resection of noncolorectal and nonneuroendocrine liver metastases: late metastases are the only chance of cure. World J Surg 25:1532–1536

    Article  CAS  PubMed  Google Scholar 

  36. Ercolani G, Grazi GL, Ravaioli M et al (2005) The role of liver resections for noncolorectal, nonneuroendocrine metastases: experience with 142 observed cases. Ann Surg Oncol 12:459–466

    Article  PubMed  Google Scholar 

  37. Yedibela S, Gohl J, Graz V et al (2005) Changes in indication and results after resection of hepatic metastases from noncolorectal primary tumors: a single-institutional review. Ann Surg Oncol 12:778–785

    Article  PubMed  Google Scholar 

  38. Schmelzle M, Eisenberger CF, am Esch JS 2nd et al (2010) Non-colorectal, non-neuroendocrine, and non-sarcoma metastases of the liver: resection as a promising tool in the palliative management. Langenbecks Arch Surg 395:227–234

  39. Marudanayagam R, Sandhu B, Perera MT et al (2011) Hepatic resection for non-colorectal, non-neuroendocrine, non-sarcoma metastasis: a single-centre experience. HPB (Oxford) 13:286–292

    Article  Google Scholar 

  40. Kleeff J, Reiser C, Hinz U et al (2007) Surgery for recurrent pancreatic ductal adenocarcinoma. Ann Surg 245:566–572

    Article  PubMed  PubMed Central  Google Scholar 

  41. Thomas RM, Truty MJ, Nogueras-Gonzalez GM et al (2012) Selective reoperation for locally recurrent or metastatic pancreatic ductal adenocarcinoma following primary pancreatic resection. J Gastrointest Surg 16:1696–1704

    Article  PubMed  Google Scholar 

  42. Fong Y (2013) Chemotherapy and resection for colorectal metastases. Lancet Oncol 14:1148–1149

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. First Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan

    Hiroaki Motoyama, Akira Kobayashi, Takahide Yokoyama, Akira Shimizu, Noriyuki Kitagawa, Tsuyoshi Notake, Kentaro Fukushima, Hitoshi Masuo, Takahiro Yoshizawa & Shin-ichi Miyagawa

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  1. Hiroaki Motoyama
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  2. Akira Kobayashi
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  3. Takahide Yokoyama
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  4. Akira Shimizu
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Correspondence to Akira Kobayashi.

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Motoyama, H., Kobayashi, A., Yokoyama, T. et al. Survival Benefits of Surgical Resection in Patients with Recurrent Biliary Tract Carcinoma. World J Surg 41, 2817–2829 (2017). https://doi.org/10.1007/s00268-017-4107-3

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  • DOI: https://doi.org/10.1007/s00268-017-4107-3

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