TY - JOUR
T1 - Is Repeat Resection for Recurrent Intrahepatic Cholangiocarcinoma Warranted? Outcomes of an International Analysis
AU - Holzner, Matthew L.
AU - Mazzaferro, Vincenzo
AU - Busset, Michele Droz Dit
AU - Aldrighetti, Luca
AU - Ratti, Francesca
AU - Hasegawa, Kiyoshi
AU - Arita, Junichi
AU - Sapisochin, Gonzalo
AU - Abreu, Phillipe
AU - Schoning, Wenzel
AU - Schmelzle, Mortiz
AU - Nevermann, Nora
AU - Pratschke, Johann
AU - Florman, Sander
AU - Halazun, Karim
AU - Schwartz, Myron E.
AU - Tabrizian, Parissa
N1 - Publisher Copyright:
© Society of Surgical Oncology 2024.
PY - 2024/7
Y1 - 2024/7
N2 - 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.
AB - 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.
KW - Intrahepatic cholangiocarcinoma
KW - Liver cancer
KW - Liver resection
KW - Locoregional therapy
KW - Recurrence
KW - Repeat resection
KW - Systemic therapy
UR - http://www.scopus.com/inward/record.url?scp=85184874030&partnerID=8YFLogxK
U2 - 10.1245/s10434-024-14975-w
DO - 10.1245/s10434-024-14975-w
M3 - Article
C2 - 38334851
AN - SCOPUS:85184874030
SN - 1068-9265
VL - 31
SP - 4397
EP - 4404
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
IS - 7
ER -