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Effectiveness of repeat surgery for recurrence after primary hepatectomy in patients with intrahepatic cholangiocarcinoma

International Journal of Clinical Oncology volume 25, pages 2083–2089 (2020)Cite this article

Abstract

Background

Intrahepatic cholangiocarcinoma (IHCC) has a poor prognosis, and surgery remains the only effective treatment. However, tumor recurrence after primary hepatectomy is common. We examined the significance of repeat surgery for IHCC.

Methods

We collected data for all patients with IHCC between 1992 and 2018 (n = 67) in our database. Fifty-three (79.1%) of all 67 patients experienced recurrence after primary hepatectomy and we analyzed data for those 53 recurrent patients. We divided recurrent patients into a repeat surgery group (n = 9), chemotherapy group (n = 19), and best supportive care group (n = 25). We analyzed differences in patients’ clinicopathological factors, including prognosis, between the three groups.

Results

The IHCC recurrence rate after hepatectomy in our institution was 79.1%. Of the 53 patients with recurrence, nine underwent repeat surgery (17.0%). The characteristics of the patients undergoing repeat surgery was lower stage at primary hepatectomy. Recurrence sites in the repeat surgery group were liver (n = 6), lung (n = 2), and adrenal gland (n = 1), as a single nodule. The period between primary hepatectomy and recurrence was comparatively longer in the repeat surgery group, at 1.8 years. The prognosis in patients undergoing repeat surgery was significantly better compared with the other groups. Not undergoing repeat surgery (hazard ratio: 5.506; p = 0.0077) and positive lymph node metastasis (hazard ratio: 2.207; p = 0.0242) were independent poor prognostic factors.

Conclusions

Repeat surgery should be considered in patients with IHCC with a single recurrence site and negative lymph node metastasis at primary surgery and at least more than 6 months of disease-free period after primary surgery.

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Affiliations

  1. Department of Surgery, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan

    Kazunori Tokuda, Yuji Morine, Yu Saito, Shinichiro Yamada, Katsuki Miyazaki, Shoko Yamashita, Shohei Okikawa, Tetsuya Ikemoto, Satoru Imura & Mitsuo Shimada

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  1. Kazunori Tokuda
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  2. Yuji Morine
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  3. Yu Saito
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  4. Shinichiro Yamada
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  5. Katsuki Miyazaki
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  6. Shoko Yamashita
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  7. Shohei Okikawa
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  8. Tetsuya Ikemoto
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  9. Satoru Imura
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  10. Mitsuo Shimada
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Correspondence to Yuji Morine.

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Tokuda, K., Morine, Y., Saito, Y. et al. Effectiveness of repeat surgery for recurrence after primary hepatectomy in patients with intrahepatic cholangiocarcinoma. Int J Clin Oncol 25, 2083–2089 (2020). https://doi.org/10.1007/s10147-020-01775-x

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  • DOI: https://doi.org/10.1007/s10147-020-01775-x

Keywords

  • Intrahepatic cholangiocarcinoma
  • Recurrence
  • Repeat surgery