Recurrence Rate and Pattern of Perihilar Cholangiocarcinoma after Curative Intent Resection

• Published in: Journal of the American College of Surgeons Vol. 221; no. 6; pp. 1041 - 1049
• Main Authors: Groot Koerkamp, Bas, MD, PhD, Wiggers, Jimme K., MD, Allen, Peter J., MD, FACS, Besselink, Marc G., MD, PhD, Blumgart, Leslie H., MD, FACS, Busch, Olivier R.C., MD, PhD, Coelen, Robert J., MD, D'Angelica, Michael I., MD, FACS, DeMatteo, Ronald P., MD, FACS, Gouma, Dirk J., MD, PhD, Kingham, T. Peter, MD, FACS, Jarnagin, William R., MD, FACS, van Gulik, Thomas M., MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2015
• Subjects: Aged; Bile Duct Neoplasms - mortality; Bile Duct Neoplasms - pathology; Bile Duct Neoplasms - surgery; Cohort Studies; Disease-Free Survival; Female; Hepatectomy; Humans; Jejunostomy; Klatskin Tumor - mortality; Klatskin Tumor - secondary; Klatskin Tumor - surgery; Male; Middle Aged; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - pathology; Neoplasm Staging; Risk Factors; Surgery; Treatment Outcome; PSC; Academic Medical Center; OS; MSKCC; perihilar cholangiocarcinoma; HR; PHC; American Joint Committee on Cancer; recurrence-free survival; AJCC; AMC; hazard ratio; overall survival; Memorial Sloan Kettering Cancer Center; primary sclerosing cholangitis; RFS
• ISSN: 1072-7515; 1879-1190
• DOI: 10.1016/j.jamcollsurg.2015.09.005

Background The aim of this study was to investigate the rate and pattern of recurrence after curative intent resection of perihilar cholangiocarcinoma (PHC). Study Design Patients were included from 2 prospectively maintained databases. Recurrences were categorized by site. Time to recurrence and recurrence-free survival (RFS) were estimated using the Kaplan-Meier method. Cox proportional hazards modeling was used to identify independent poor prognostic factors. Results Between 1991 and 2012, 306 consecutive patients met inclusion criteria. Median overall survival was 40 months. A recurrence was diagnosed in 177 patients (58%). An initial local recurrence was found in 26% of patients: liver hilum (11%), hepaticojejunostomy (8%), liver resection margin (8%), or distal bile duct remnant (2%). An initial distant recurrence was observed in 40% of patients: retroperitoneal lymph nodes (14%), intrahepatic away from the resection margin (13%), peritoneum (12%), and lungs (8%). Only 18% of patients had an isolated initial local recurrence. The estimated overall recurrence rate was 76% at 8 years. After a recurrence-free period of 5 years, 28% of patients developed a recurrence in the next 3 years. Median RFS was 26 months. Independent prognostic factors for RFS were resection margin, lymph node status, and tumor differentiation. Only node-positive PHC precluded RFS beyond 7 years. Conclusions Perihilar cholangiocarcinoma will recur in most patients (76%) after resection, emphasizing the need for better adjuvant strategies. The high recurrence rate of up to 8 years justifies prolonged surveillance. Only patients with an isolated initial local recurrence (18%) may have benefited from a more extensive resection or liver transplantation. Node-positive PHC appears incurable.