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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



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.


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].


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



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.

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Correspondence to Parissa Tabrizian MD, MSc.

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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 31, 4397–4404 (2024).

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