Time to Recurrence After Surgical Resection and Survival After Recurrence Among Patients with Perihilar and Distal Chola
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ORIGINAL ARTICLE – HEPATOBILIARY TUMORS
Time to Recurrence After Surgical Resection and Survival After Recurrence Among Patients with Perihilar and Distal Cholangiocarcinomas Yoshitsugu Nakanishi, MD, PhD1, Keisuke Okamura, MD, PhD1, Takahiro Tsuchikawa, MD, PhD1, Toru Nakamura, MD, PhD1, Takehiro Noji, MD, PhD1, Toshimichi Asano, MD, PhD1, Aya Matsui, MD, PhD1, Kimitaka Tanaka, MD, PhD1, Soichi Murakami, MD, PhD1, Yuma Ebihara, MD, PhD1, Yo Kurashima, MD, PhD1, Hajime Narasaki, MD, PhD1, Toraji Amano, MD, PhD2, Toshiaki Shichinohe, MD, PhD1, and Satoshi Hirano, MD, PhD1 1 2
Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan; Clinical Research and Medical Innovation Centre, Hokkaido University Hospital, Sapporo, Japan
ABSTRACT Background. The differences between perihilar cholangiocarcinoma (PHCC) and distal cholangiocarcinoma (DCC) regarding recurrence and the factors that affect recurrence after surgery are unclear. This study aims to investigate the differences in recurrence patterns between patients with PHCC and those with DCC after surgical resection with curative intent. It also investigates the risk factors associated with recurrence and survival thereafter. Patients and Methods. The postoperative courses of 366 patients with extrahepatic cholangiocarcinomas (EHCCs), including 236 with PHCC and 130 with DCC, who underwent surgical resections were investigated retrospectively. Results. During follow-up, tumors recurred in 143 (60.6%) patients with PHCC and in 72 (55.4%) patients with DCC. Overall survival (OS) after surgery, recurrencefree survival (RFS), and OS after recurrence were similar for the patients with PHCC and those with DCC. The cumulative probability of recurrence declined 3 years after
Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-020-08534-2) contains supplementary material, which is available to authorized users. Ó Society of Surgical Oncology 2020 First Received: 15 December 2019 Y. Nakanishi, MD, PhD e-mail: [email protected]
surgery in the patients with PHCC and those with DCC. A multivariable analysis determined that, among the patients with PHCC and those with DCC, regional lymph node metastasis was a significant risk factor associated with RFS. Ten patients with PHCC and eight patients with DCC with two or fewer sites of recurrence in a single organ underwent resections. A multivariable analysis determined that recurrent tumor resection was an independent prognostic factor associated with OS after recurrence in the patients with PHCC and those with DCC. Conclusions. Postoperative survival did not differ between the patients with PHCC and those with DCC. Frequent surveillances for recurrence are needed for 3 years after surgical resection of EHCCs. In selected patients, surgery for recurrent EHCCs might be associated with improved outcomes.
Extrahepatic cholangiocarcinoma (EHCC) is a malignant disease that arises from the extrahepatic bile duct. EHCCs are classifi
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