Recurrence of hilar cholangiocarcinoma after surgical resection: is there a role of surgery?

Abstract

Aim To evaluate our experience in management of recurrent perihilar cholangiocarcinoma (pCCA) and to detect whether surgical re-resection is of value in these cases or not. Patients and methods We revised our data for patients who underwent surgical resection for pCCA during the period between May 1995 and December 2010. Results During this period, 263 cases underwent surgical exploration for pCCA. After a median follow-up duration of 18 months (4–89), recurrence occurred in 136 (51.7%) patients and mortality occurred in 157 (59.7%) patients. The 1-, 3-, and 5-year disease-free and overall survival rates were 82.7, 41.5, and 35% and 86.7, 52, and 47.6%, respectively. Nine redo-resections were performed for eight (3%) patients with recurrence at biliary anastomosis. The redo-surgery group achieved a better overall survival rates when compared with biliary drainage group (Log-rank=0.046) and when compared with the nonoperated group (Log-rank=0.032). Conclusion Surgical re-resection of recurrent pCCA is a feasible and technically challenging procedure in selected patients. It is associated with acceptable perioperative morbidities and provides a better survival benefit compared with other palliative procedures.