Sun Choon Song, et al. current disease in the case of intrahepatic, perihilar, and patient who had a locoregional recurrence in the pancreas extrahepatic cholangiocarcinoma, respectively (Table 2). after right tri-segmentectomy for type IIIA hilar cholan- The recurrent rate was highest after pancreaticoduo- giocarcinoma. One patient had a recurrence in regional denectomy (37.0%) for extrahepatic cholangiocarcinoma. lymph nodes 17.4 months after left lateral sectionectomy The recurrent sites were as follows; solitary (n = 83) or mul- for intrahepatic cholangiocarcinoma located at segments tiple (n = 17) hepatic recurrence, locoregional recurrence II and III (Table 3). In the current study, we did not perform except liver (n = 118), peritoneal seeding (n = 49), lung or surgical resection or RFA for multiple hepatic metastatic pleura (n = 20), abdominal or chest wall (n = 7), bone (n = 5), lesions, and surgical procedures for peritoneal seeding, brain (n = 2), supraclavicular lymph node (n = 2) and multi- supraclavicular lymph node and bone or brain metastasis. ple site recurrence (n = 13). 180, 80 and 56 patients had recurrence within 1 year, Hepatic resection or RFA was performed for liver from 1 to 2 years, and above 2 years, respectively. During metastasis. Pancreaticoduodenectomy, partial pancrea- these periods, various treatments for recurrence were per- tectomy, and regional lymph node dissection were per- formed for locoregional recurrent lesions. Metastasecto- my was performed for recurrent masses in the abdominal or chest wall, lung or pleura, and peritoneal solitary metastasis. Partial pancreatectomy was performed on one Table 2. Recurrent rates according to the tumor types after R0, R1 resection Types Recurrent rates (%) Surgical RFA resection treatment (n) (n) Intrahepatic 74/226 (32.7) Perihilar 78/222 (35.1) Extrahepatic Segmental bile duct 33/120 (27.5) resection Pancreaticoduodenectomy 131/354 (37.0) Total 316/921 (34.3) RFA, Radiofrequency ablation. Table 3. Treatment types for recurrence Treatment (n) 5 9 8 5 27 3 1 1 2 7 Table 4. Patterns of recurrence according to the recurrent sites and time-to-recurrence Recurrent sites Liver, solitary Liver, multiple Locoregional except liver Lung or pleura Abdominal or chest wall Peritoneum, solitary Peritoneal seeding Bone Brain Supraclavicular lymph nodes Multiple sites Total Comments Time-to-recurrence (treatment case/total) Within 1 yr From 1 to 2 yr Above 2 yr 7/52 0/14 3/48 1/10 3/5 1/1 0/36 0/4 0/1 0/1 0/8 15/180 1/21 0/3 3/40 1/5 1/1 1/1 0/5 0/0 0/1 0/1 1/2 8/80 1/10 0/0 7/30 0/5 1/1 0/0 0/6 0/1 0/0 0/0 2/3 11/56 Liver resection (7) Right hemi-hepatectomy (1), Left hemi-hepatectomy (1), Wedge resection (1), Sectionectomy (2), Tumorectomy (2a)) Metastasectomy (10) Chest wall (3), Abdominal wall (2), Peritoneum (2), VATs-WR of lung (3b)) Pancreaticoduodenectomy (8) Whipple’s procedure (4), PPPD (4) Partial pancreatectomy (1) This patient previously underwent right trisegmentectomy due to hilar cholangiocarcinoma. After 14 months, he underwent intra-operative RFA due to second recurrence at hepatic resection margin Regional lymph node dissection (1) Intrahepatic cholangiocarcinoma with lymph node metastasis RFA (7) All were percutaneous RFA VATs-WR, video-assisted thoracic surgery-wedge resection, PPPD, pylorus-preserving pancreaticoduodenectomy, RFA, radiofrequency ablation. a)One patient underwent RFA after 2 months due to second hepatic recurrence. b)One patient underwent hepatic tumorectomy after 1 month due to second hepatic recurrence. 190 thesurgery.or.kr