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AIM:
The aim of this study was to clarify the risk factors, the pattern of occurrence and the results of treatment of recurrence in patients affected by cholangiocarcinoma submitted to surgical resection for peri-hilar (PCC) and intrahepatic cholangiocarcinoma (ICC).
METHODS:
We retrospectively analyzed the clinicopathologic data of 132 patients submitted to liver resection with curative intent from January 1990 to July 2011, 71 of whom affected by PCC and 61 withICC. Thirty-two patients for both groups developed recurrence during the follow-up period (45% and 52.5%, respectively). We estimated the risk factors, the onset pattern of recurrence and the impact of treatment on survival in these patients.
RESULTS:
The 3- and 5-year disease-free survival was 41% and 21% for both groups (p=0.35). Among the patients affected by PCC, 11 (34%) developed intrahepatic recurrence, 5 (15%) developed peritoneal carcinomatosis, 4 (13%) anastomotic and 4 (13%) lymph-nodal recurrence. Percutaneous transhepatic biliary drainage catheter tract recurrence occurred in 3 patients (9%). At univariate analysis, the tumor size, the macroscopical portal involvement and elevated serum level of Ca 19.9 were significantly associated with recurrence. In the intrahepatic cholangiocarcinoma group, 19 patients (59%) developed intrahepatic recurrence. Five factors were significantly associated with recurrence at univariate analysis in this group: tumor size, serum level of Ca 19.9 and CEA, multifocal disease at resection and grading. The overall 3-year survival after recurrence was 17%. The type of treatment was different between two groups. In patients with PCC, 5 (9%) patients were submitted to surgical treatment of recurrence followed by chemotherapy, 19 (60%) underwent only chemotherapy, while 8 (25%) received supportive care. In patients affected by ICC, Five patients (16%) received surgical treatment, 13 (41%) chemo- or radiotherapy and 14 (43%) only supportive care. Regarding the impact of treatment on survival, the median survivals in patients submitted to surgery, chemotherapy or supportive care were 45.5, 12.5, and 2.9 months respectively (p<0.05).
CONCLUSIONS:
Recurrence after liver resection with curative intent is correlated to a poor prognosis. When feasible, aggressive treatment with radical resection of recurrence can improve the prognosis in these patients.