Outcome after liver resection for primary and recurrent intrahepatic cholangiocarcinoma

Background Liver resection is the only curative therapeutic option for intrahepatic cholangiocarcinoma (ICC), but the approach to recurrent ICC is controversial. This study analysed the outcome of liver resection in patients with recurrent ICC. Methods Demographic, radiological, clinical, operative, surgical pathological and follow-up data for all patients with a final surgical pathological diagnosis of ICC treated in a tertiary referral centre between 2001 and 2015 were collected retrospectively and analysed. Results A total of 190 patients had liver resection for primary ICC. The 1-, 3- and 5-year overall survival (OS) rates were 74 center dot 8, 56 center dot 6 and 37 center dot 9 per cent respectively. Independent determinants of OS were age 65 years or above (hazard ratio (HR) 2 center dot 18, 95 per cent c.i. 1 center dot 18 to 4 center dot 0; P = 0 center dot 012), median tumour diameter 5 cm or greater (HR 2 center dot 87, 1 center dot 37 to 6 center dot 00; P = 0 center dot 005), preoperative biliary drainage (HR 2 center dot 65, 1 center dot 13 to 6 center dot 20; P = 0 center dot 025) and local R1-2 status (HR 1 center dot 90, 1 center dot 02 to 3 center dot 53; P = 0 center dot 043). Recurrence was documented in 87 patients (45 center dot 8 per cent). The mean(s.d.) survival time after recurrence was 16(17) months. Independent determinants of recurrence were median tumour diameter 5 cm or more (HR 1 center dot 71, 1 center dot 09 to 2 center dot 68; P = 0 center dot 020), high-grade (G3-4) tumour (HR 1 center dot 63, 1 center dot 04 to 2 center dot 55; P = 0 center dot 034) and local R1 status (HR 1 center dot 70, 1 center dot 09 to 2 center dot 65; P = 0 center dot 020). Repeat resection with curative intent was performed in 25 patients for recurrent ICC, achieving a mean survival of 25 (95 per cent c.i. 16 to 34) months after the diagnosis of recurrence. Patients deemed to have unresectable disease after recurrence received chemotherapy or chemoradiotherapy alone, and had significantly poorer survival. Conclusion Patients with recurrent ICC may benefit from repeat surgical resection.