Treatment of recurrent intrahepatic cholangiocarcinoma

Background: The aims of this study were to evaluate risk factors for recurrence following hepatectomy with curative intent for intrahepatic cholangiocarcinoma (ICC), and predictors of survival after intrahepatic recurrence. Methods: All patients with ICC who underwent liver resection between January 1997 and August 2011 in a single centre were analysed retrospectively. Clinicopathological factors likely to influence recurrence and postrecurrence survival were assessed by univariable and multivariable analysis. Results: A total of 87 patients were analysed. R0 resection was achieved in 65 patients (75 per cent). Eighty-three patients survived more than 1 month after resection. Median survival was 33 months, with 1-, 3- and 5-year actuarial survival rates of 79, 47 and 31 per cent respectively. Recurrence occurred in 45 (54 per cent) of the 83 patients, most frequently in the liver (25 patients). Satellite nodules (odds ratio (OR) 8.17, 95 per cent confidence interval 1.38 to 48.53; P = 0.021), hilar lymph node metastases (OR 5.24, 1.07 to 25.75; P = 0.041) and perineural invasion (OR 9.68, 1.07 to 87.54; P = 0.043) were identified as independent risk factors for recurrence. Repeat hepatectomy (P = 0.003) and intra-arterial yttrium-90 radiotherapy (P = 0.048) were associated with longer survival after intrahepatic recurrence. Conclusion: Satellite nodules, hilar lymph node metastases and perineural invasion are risk factors for recurrence following resection with curative intent for ICC. Repeat hepatectomy and labelled yttrium-90 radiotherapy may improve survival after intrahepatic recurrence. Copyright (c) 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.