Tsai Chun-Yi, Wang Shang-Yu, Chan Kun-Ming, Lee Wei-Chen, Chen Tse-Ching, Yeh Ta-Sen, Jan Yi-Yin, Yeh Chun-Nan
Department of General Surgery, Chang Gung Memorial Hospital, Linkou Branch, Chang Gung University, Taoyuan 333, Taiwan.
Liver Research Center, Chang Gung Memorial Hospital, Linkou Branch, Chang Gung University, Taoyuan 333, Taiwan.
J Pers Med. 2022 Mar 29;12(4):540. doi: 10.3390/jpm12040540.
Introduction: Intrahepatic cholangiocarcinoma (ICC) has devastating outcomes owing to its advanced stage at diagnosis and high recurrence after hepatectomy. There is no preferred treatment for recurrent ICC. We retrospectively reviewed our patients who underwent repeated operations for recurrent ICCs based on their different indications to appraise the outcomes. Methods: In all, 160 out of 216 patients with ICC (71.4%) experienced recurrence after curative resection from 1977 to 2014. The patterns of recurrence were categorized according to the locations and numbers of recurrent tumors. Results: Patients with merely intrahepatic recurrence (n = 38) had superior overall survival (OS) compared with those with beyond intrahepatic recurrence (p < 0.0001). Twenty-seven out of 160 patients (16.8%) underwent repeat hepatectomy or/with metastatectomy for recurrence and had superior OS when compared to the remaining 133 patients who received nonoperative treatment/palliation (85.6 months versus 20.9 months, p < 0.001). Furthermore, patients suitable for repeat hepatectomy in the intrahepatic recurrent group (n = 12) had superior post-recurrence overall survival (PROS) than the remaining 26 patients receiving nonoperative treatment (61.6 months versus 14.7 months, p < 0.05). Conclusion: Liver is the most commonly involved site of recurrent ICC. However, merely intrahepatic recurrence may have a favorable prognosis compared to recurrence involving other sites. Aggressive hepatectomy may provide a survival benefit in selected patients.
肝内胆管癌（ICC）因其诊断时处于晚期以及肝切除术后高复发率而导致预后不佳。目前对于复发性ICC尚无首选治疗方法。我们回顾性分析了因不同指征接受复发性ICC再次手术的患者，以评估治疗效果。方法：1977年至2014年间，216例ICC患者中有160例（71.4%）在根治性切除术后复发。根据复发肿瘤的位置和数量对复发模式进行分类。结果：单纯肝内复发患者（n = 38）的总生存期（OS）优于肝外复发患者（p < 0.0001）。160例患者中有27例（16.8%）因复发接受了再次肝切除或/和转移灶切除术，与其余133例接受非手术治疗/姑息治疗的患者相比，其OS更长（85.6个月对20.9个月，p < 0.001）。此外，肝内复发组中适合再次肝切除的患者（n = 12）的复发后总生存期（PROS）优于其余26例接受非手术治疗的患者（61.6个月对14.7个月，p < 0.05）。结论：肝脏是复发性ICC最常累及的部位。然而，与累及其他部位的复发相比，单纯肝内复发可能预后较好。积极的肝切除术可能为部分患者带来生存获益。
