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Effect of local treatment in patients with oligo-recurrence after surgery of distal bile duct cancer: A bi-institutional study

 So Jeong Yoon  ;  Seung Soo Hong  ;  Min Jae Gwon  ;  Sang Hyun Shin  ;  Jin Seok Heo  ;  Chang Moo Kang  ;  Kyung Sik Kim  ;  Ho Kyoung Hwang  ;  In Woong Han 
 CANCER MEDICINE, Vol.12(10) : 11274-11283, 2023-05 
Journal Title
Issue Date
Bile Duct Neoplasms* / pathology ; Bile Ducts, Extrahepatic* / pathology ; Cholangiocarcinoma* / pathology ; Cholecystectomy ; Humans ; Neoplasm Recurrence, Local / pathology ; Prognosis ; Retrospective Studies
bile duct cancer ; cholangiocarcinoma ; oligo-recurrence ; recurrence ; survival
Background: Distal extrahepatic bile duct (EHBD) cancer is highly recurrent. More than 50% of patients suffer from disease relapse after curative resection. Some patients present with oligo-recurrence which could be a single loco-regional mass or lesions limited to a single solid organ. The aim of this study was to examine the effect of local control (surgical resection or radiofrequency ablation) on survival outcomes in patients with oligo-recurrent distal EHBD cancer.

Methods: Data of 1219 patients who underwent surgery for distal EHBD cancer from 2000 to 2018 were retrospectively reviewed. Clinicopathological characteristics and survival outcomes of patients with recurrence were investigated. Post-recurrence survival (PRS) was analyzed according to modalities of re-treatment (local treatment or systemic therapy alone).

Results: Among 654 patients with recurrence, 90 patients who had oligo-recurrence showed better recurrence-free and overall survival than patients with non-oligo-recurrent disease. Lymph node ratio and perineural invasion at initial pathology, timing of recurrence, and platelet-to-lymphocyte ratio at recurrence were independent risk factors for PRS in the oligo-recurrent group. Patients with local treatment for oligo-recurrence had better 3- and 5-year PRS than those with systemic treatment alone (38.3% vs. 14.1%, p = 0.04; 28.3% vs. 7.1%, p = 0.04, respectively). Recurrence within 24 months after initial surgery was the only significant factor for PRS in the local treatment group.

Conclusion: In patients with oligo-recurrence after resection of distal EHBD cancer, post-recurrence local treatment could improve survival outcomes, particularly for those with recurrence more than 2 years after initial resection.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Chang Moo(강창무) ORCID logo https://orcid.org/0000-0002-5382-4658
Kim, Kyung Sik(김경식) ORCID logo https://orcid.org/0000-0001-9498-284X
Hong, Seung Soo(홍승수)
Hwang, Ho Kyoung(황호경) ORCID logo https://orcid.org/0000-0003-4064-7776
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