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. 2022 Mar 29;12(4):540.
doi: 10.3390/jpm12040540.

Hepatectomy or/with Metastatectomy for Recurrent Intrahepatic Cholangiocarcinoma: Of Promise for Selected Patients

Chun-Yi Tsai  1 , Shang-Yu Wang  1   2 , Kun-Ming Chan  1 , Wei-Chen Lee  1 , Tse-Ching Chen  3 , Ta-Sen Yeh  1   2 , Yi-Yin Jan  1 , Chun-Nan Yeh  1   2
Affiliations

Hepatectomy or/with Metastatectomy for Recurrent Intrahepatic Cholangiocarcinoma: Of Promise for Selected Patients

Chun-Yi Tsai et al. J Pers Med. .

Abstract

Introduction: Intrahepatic cholangiocarcinoma (ICC) has devastating outcomes owing to its advanced stage at diagnosis and high recurrence after hepatectomy. There is no preferred treatment for recurrent ICC. We retrospectively reviewed our patients who underwent repeated operations for recurrent ICCs based on their different indications to appraise the outcomes. Methods: In all, 160 out of 216 patients with ICC (71.4%) experienced recurrence after curative resection from 1977 to 2014. The patterns of recurrence were categorized according to the locations and numbers of recurrent tumors. Results: Patients with merely intrahepatic recurrence (n = 38) had superior overall survival (OS) compared with those with beyond intrahepatic recurrence (p < 0.0001). Twenty-seven out of 160 patients (16.8%) underwent repeat hepatectomy or/with metastatectomy for recurrence and had superior OS when compared to the remaining 133 patients who received nonoperative treatment/palliation (85.6 months versus 20.9 months, p < 0.001). Furthermore, patients suitable for repeat hepatectomy in the intrahepatic recurrent group (n = 12) had superior post-recurrence overall survival (PROS) than the remaining 26 patients receiving nonoperative treatment (61.6 months versus 14.7 months, p < 0.05). Conclusion: Liver is the most commonly involved site of recurrent ICC. However, merely intrahepatic recurrence may have a favorable prognosis compared to recurrence involving other sites. Aggressive hepatectomy may provide a survival benefit in selected patients.

Keywords: hepatectomy; intrahepatic cholangiocarcinoma; metastatectomy; overall survival; recurrent intrahepatic cholangiocarcinoma.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
The algorithm and flowchart of patient selection.
Figure 2
Figure 2
The distribution of recurrent tumors based on their locations and numbers.
Figure 3
Figure 3
The comparison of overall survival (OS) among the three different recurrent patterns, represented by groups A, B, and C.
Figure 4
Figure 4
The difference in post-recurrence overall survival (PROS) between the patients who underwent repeat operation and those who did not.
Figure 5
Figure 5
The individual number of patients who underwent a second operation within each group.
Figure 6
Figure 6
The post-recurrence overall survival (PROS) according to the types of surgery applied within groups A and B. The first line indicates that the patients with isolated intrahepatic recurrence underwent repeat hepatectomy alone in group A (n = 12), compared to the third line, which represents the nonoperative patients (n = 26) within group A. The second line indicates the patients with locoregional recurrence who underwent hepatectomy or/with metastatectomy in group B (n = 11), and the fourth line indicates the nonoperative patients within group B (n = 46).
Figure 7
Figure 7
The difference in post-recurrence overall survival (PROS) between the nonoperative patients within group A and the nonoperative patients within groups B and C.
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