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LONG TERM OUTCOME OF SURGERY FOR RECURRENT BILE DUCT CARCINOMA
Minoru Esaki*, Satoshi Nara, Kengo Fukuoka, Toshimitsu Iwasaki, Yoji Kishi, Kazuaki Shimada
Hepatobiliary and pancreatic surgery, National Cancer Center Hospital, Tokyo, Japan
Background: Although several studies have reported on chemotherapy for recurrence after surgery for perihilar bile duct carcinoma (PBC) or distal bile duct carcinoma (DBC), data on survival difference according to recurrence type and outcomes of metastasectomy are limited. The aim of this study is to clarify association between prognosis and initial recurrence type and efficacy of metastasectomy for recurrent PBC and DBC.
Methods: Medical records of patients who underwent resection for PBC or DBC between 2000 and 2014 in our institution, focused on initial recurrent site and type of treatment, were retrospectively evaluated. Indications of metastasectomy in principle are as follows: 2 years after initial resection, solitary lesion with several months' observation, technically and anatomically resectable, and more aggressive indication for lung or liver metastasis exceptionally.
Results: A total 413 patients were enrolled. Two hundred sixty four hepatectomies with extrahepatic bile duct resections (HR), 109 pancreaticoduodenectomies (PD), and 40 other procedures were performed for PBC or DBC. Three/ five year survival rates/ mean survival time after surgery for PBC and DBC were 52%/ 42%/ 38.4months and 64%/ 55%/ 84.6months, respectively (significantly different; P=0.015). Disease recurrence observed in 225 patients (54%) (median follow-up time: 29 [1-459] months). Cumulative survival rates at 1/ 3 years after recurrence and median survival time were 42%/ 10% and 9 months, respectively. Survival of 52 patients with multiple site recurrence was not significantly worse than that of 173 patients with single site recurrence (lung 14 cases, liver 41, lymphnode 16 and others (locoregional, etc.) 102) (P=0.121). Survival after treatment for single site recurrence was significantly different among the each recurrence site (1/ 3 years survival rates after recurrence/ mean survival time: lung 92%/ 49%/ 29.6 months, liver 40%/ 13%/ 10.2 months, lymphnode 63%/ 0%/ 15.0 months (lung vs liver: P=0.020, liver vs others: P=0.039, lymphnode vs others: P=0.092)). Survival after recurrence was favorable in 15 patients (4%) who underwent metastasectomy (S group: lung 4, liver 5, peritoneum 1, others 5). 124 patients underwent chemotherapy or/and radiotherapy (CR group) and other 86 patients received best supportive care alone (B group) due to poor general condition, severe cholangitis, and high age. One / three year survival rates / median survival time was significantly different among 3 treatment groups(S group: 64%/ 45%/ 22.3 months, CR group: 60%/ 13%/ 15.7 months, B group: 23% / 4%/ 4.6 months: S vs CR; P=0.038, CR vs B; P<0.001).
Conclusions: Lung and liver recurrence after resection of PBC or DBC indicates better prognosis than other recurrent site. Surgical resection for recurrent bile duct carcinoma may provide favorable outcome in selected patients.
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