• Bas Groot Koerkamp, Jimme K Wiggers, Peter J Allen, Marc G Besselink, Leslie H Blumgart, Olivier R C Busch, Robert J Coelen, Michael I D'Angelica, Ronald P DeMatteo, Dirk J Gouma, T Peter Kingham, William R Jarnagin, and Thomas M van Gulik.
• Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. Electronic address: b.grootkoerkamp@erasmusmc.nl.
• J. Am. Coll. Surg. 2015 Dec 1;221(6):1041-9.

BackgroundThe aim of this study was to investigate the rate and pattern of recurrence after curative intent resection of perihilar cholangiocarcinoma (PHC).Study DesignPatients were included from 2 prospectively maintained databases. Recurrences were categorized by site. Time to recurrence and recurrence-free survival (RFS) were estimated using the Kaplan-Meier method. Cox proportional hazards modeling was used to identify independent poor prognostic factors.ResultsBetween 1991 and 2012, 306 consecutive patients met inclusion criteria. Median overall survival was 40 months. A recurrence was diagnosed in 177 patients (58%). An initial local recurrence was found in 26% of patients: liver hilum (11%), hepaticojejunostomy (8%), liver resection margin (8%), or distal bile duct remnant (2%). An initial distant recurrence was observed in 40% of patients: retroperitoneal lymph nodes (14%), intrahepatic away from the resection margin (13%), peritoneum (12%), and lungs (8%). Only 18% of patients had an isolated initial local recurrence. The estimated overall recurrence rate was 76% at 8 years. After a recurrence-free period of 5 years, 28% of patients developed a recurrence in the next 3 years. Median RFS was 26 months. Independent prognostic factors for RFS were resection margin, lymph node status, and tumor differentiation. Only node-positive PHC precluded RFS beyond 7 years.ConclusionsPerihilar cholangiocarcinoma will recur in most patients (76%) after resection, emphasizing the need for better adjuvant strategies. The high recurrence rate of up to 8 years justifies prolonged surveillance. Only patients with an isolated initial local recurrence (18%) may have benefited from a more extensive resection or liver transplantation. Node-positive PHC appears incurable.Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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