Is Repeat Resection for Recurrent Intrahepatic Cholangiocarcinoma Warranted? Outcomes of an International Analysis

Matthew L. Holzner, Vincenzo Mazzaferro, Michele Droz Dit Busset, Luca Aldrighetti, Francesca Ratti, Kiyoshi Hasegawa, Junichi Arita, Gonzalo Sapisochin, Phillipe Abreu, Wenzel Schoning, Mortiz Schmelzle, Nora Nevermann, Johann Pratschke, Sander Florman, Karim Halazun, Myron E. Schwartz, Parissa Tabrizian

Research output: Contribution to journalArticlepeer-review

Abstract

Background: 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. Results: 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]. Conclusions: 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.

Original languageEnglish
JournalAnnals of Surgical Oncology
DOIs
StateAccepted/In press - 2024

Keywords

  • Intrahepatic cholangiocarcinoma
  • Liver cancer
  • Liver resection
  • Locoregional therapy
  • Recurrence
  • Repeat resection
  • Systemic therapy

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