Lang Hauke
Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
Visc Med. 2021 Feb;37(1):26-31. doi: 10.1159/000513711. Epub 2020 Dec 21.
For recurrent cholangiocarcinoma, systemic chemotherapy is the standard of care. Repeated resection is a potential curative treatment, but data are scarce and outcomes are not well defined so far.
In the last decade there has been an increasing number of reports suggesting a survival benefit and even cure after repeated surgery. This is particularly true for intrahepatic cholangiocarcinoma, where repeated resections offer similar or even better results than the first resection. In selected cases even a third liver resection is possible. In contrast, in perihilar and distal cholangiocarcinoma, repeated resection is only rarely possible. Although the improved outcome might be attributed to a careful patient selection and a favorable tumor biology, repeated surgical treatment should be attempted whenever possible. This necessitates a structured follow-up after resection.
Surgical resection offers the chance for prolonged survival and even for cure in recurrent cholangiocarcinoma. Hence, it is of the utmost importance to better understand the routes of metastases and to define factors qualifying for resection. Whether different patterns of recurrence reflect biological heterogeneity requires further investigation.
对于复发性胆管癌，全身化疗是标准治疗方法。再次手术切除是一种潜在的治愈性治疗方法，但目前数据稀少，疗效尚不明确。
在过去十年中，越来越多的报告表明再次手术后有生存获益甚至治愈的情况。肝内胆管癌尤其如此，再次手术切除的效果与首次切除相似甚至更好。在某些特定病例中，甚至可以进行第三次肝切除。相比之下，肝门部和远端胆管癌很少能进行再次手术切除。尽管预后改善可能归因于仔细的患者选择和有利的肿瘤生物学特性，但只要有可能，就应尝试再次手术治疗。这就需要在切除术后进行结构化随访。
手术切除为复发性胆管癌患者提供了延长生存期甚至治愈的机会。因此，更好地了解转移途径并确定适合切除的因素至关重要。不同的复发模式是否反映生物学异质性需要进一步研究。
