Recurrence of intrahepatic cholangiocarcinoma – Patterns and therapy

Abstract

Background: After resection of intrahepatic cholangiocarcinoma (ICC) recurrence is common, but data regarding therapy and prognosis of tumor recurrence are lacking. Methods: Patients with ICC (n = 153) were recorded prospectively (2008 – 2015). Site of recurrence, disease-free interval as well as treatment were further analysed using Kaplan Meier model for overall and recurrence free survival. Results: Out of 115 resections recurrence occurred in 70 cases (60.9 %). Location was intrahepatic (n = 30 patients; 42.9%), intra- and extrahepatic (n = 21; 30%) and extrahepatic (n = 19; 27.1%). The median recurrence free survival (RFS) was 9.2 months (range 0.4 – 68.3) with a 1-, 3- and 5-year RFS of 35%, 16% and 16%, respectively. In total, 16 re-explorations with 13 resections (81.25%) were performed (8 external primary resections) and 10 R0 resections achieved. Patients not considered for surgical therapy underwent chemotherapy (n = 40), TACE (n = 2), RFA (n = 3), SIRT (n = 1) or best supportive care (n = 16). Survival of repeated resection was significantly superior to alternative therapies (p = 0.017). The repeated resection group had a median overall survival (OS) of 61.6 months (range 11.7 – 183.8, data starting with first liver resection) with a 1-, 3- and 5-year OS rate of 90%, 68% and 54%, respectively. Conclusion: In solely intrahepatic recurrence repeated resection should be attempted to offer a chance for cure. Recurrent ICC amenable to repeated resection seem to be a positive selection associated with better survival.