Oncological outcomes of surgery for recurrent biliary tract cancer: who are the best candidates?. Issue 9 (September 2021)

• Record Type: Journal Article
• Authors: Sakata, Jun; Nomura, Tatsuya; Aono, Takashi; Kitami, Chie; Yokoyama, Naoyuki; Minagawa, Masahiro; Takizawa, Kazuyasu; Miura, Kohei; Hirose, Yuki; Ichikawa, Hiroshi; Nagahashi, Masayuki; Shimada, Yoshifumi; Kobayashi, Takashi; Wakai, Toshifumi
• Is Part Of: HPB. Volume 23:Issue 9(2021)
• Page Start: 1371
• Page End: 1382
• Publication Date: 2021-09
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1016/j.hpb.2021.01.007
• Languages: English
• ISSNs: 1365-182X

Abstract

Abstract: Background: This study aimed to investigate the impact of surgery on outcomes in patients with recurrent biliary tract cancer (BTC) and elucidate factors affecting survival after surgery for this disease. Methods: A single-center study was undertaken in 178 patients with recurrent BTC, of whom 24 underwent surgery for recurrence, 85 received chemotherapy, and 69 received best supportive care. Then, we carried out a multicenter study in 52 patients undergoing surgery for recurrent BTC (gallbladder cancer, 39%; distal cholangiocarcinoma, 27%; perihilar cholangiocarcinoma, 21%; intrahepatic cholangiocarcinoma, 13%). Results: In the single-center study, 3-year survival after recurrence was 53% in patients who underwent surgery, 4% in those who received chemotherapy, and 0% in those who received best supportive care (p < 0.001). Surgery was an independently prognostic factor (p < 0.001). In the multicenter series, the respective 3-year and 5-year survival after surgery for recurrence was 50% and 29% in the 52 patients. Initial site of recurrence was the only independent prognostic factor (p = 0.019). Five-year survival after surgery for recurrence in patients with single distant, multifocal distant, and locoregional recurrence was 51%, 0%, and 0%, respectively (p = 0.002). Sites of single distant recurrence included the liver (n = 13, 54%), distant lymph nodes (all from gallbladder cancer, n = 7, 29%), lung (n = 2, 9%), peritoneum (n = 1, 4%), and abdominal wall (n = 1, 4%). Conclusion: Surgery may be an effective option for patients with less aggressive tumor biology characterized by single distant recurrence in recurrent BTC.