Surgical treatments for recurrent cholangiocarcinoma DISCUSSION dergo surgical treatment for cholangiocarcinoma is still disappointing, although there have been recent advances in imaging modalities, peri-operative treatment, and sur- gical techniques. Additionally, because of the advanced stage at presentation, inadequate identification of anatom- ic location, and/or poor medical conditions, surgical re- Table 6. Multivariate analysis of prognostic factors on overall survival after recurrence Variables No surgical resection R1 resection Not performed adjuvant CCRT Lymph node metastasis CCRT, concurrent chemoradiotherapy. Hazard ratio 2.308 1.576 1.140 0.863 95% confidence P-value interval 1.112-4.787 1.003-2.476 0.826-1.573 0.628-1.187 0.025 0.049 0.426 0.366 formed to 9.3%, 10.0% and 19.6% of the recurrent patients, Fig. 1). The additional chemoradiotherapy did not show respectively (Table 4). Overall survival and range of survival after re- currence significant survival benefits in either group. The beneficial effect of surgical treatment for recurrent disease with re- spect to the ranges of survival was remarkable in the case of locoregional recurrence except liver and abdominal or The median times to recurrence were 15.0 and 10.1 chest wall metastasis (Table 5). Surgical resection for re- months in group A and B, respectively (P = 0.118). The me- current cholangiocarcinoma was identified as an in- dian times from recurrence to surgical treatment for re- dependent prognostic factor on overall survival according current disease in group A was 27 days (range, 14 to 182 to multivariate analysis (HR = 2.308, P = 0.025) (Table 6). days). The median survival times after recurrence were 18.9 months (range, 1.7 to 101.8 months) and 7.7 months (range, 0.5 to 89.1 months) in group A and B, respectively. The cumulative overall survival rate after recurrence was significantly higher in group A than group B (P = 0.001, The long-term survival outcomes of patients who un- Fig. 1. Overall survival rate after recurrence according to surgical treatment and concurrent chemoradiotherapy (CCRT) for recur- rent cholangiocarcinoma (group A; patients treated surgically for recurrence, group B; patients not treated, P-value between the two groups = 0.001). Table 5. Recurrent sites and ranges of survival after recurrence Liver, solitary (4) Locoregional except liver (12) Lung or pleura (2) Abdominal or chest wall (5) Peritoneum, solitary (2) Multiple site (2) thesurgery.or.kr Group A (n = 27) Group B (n = 289) Recurrent sites (n) Ranges of survival (mo) Recurrent sites (n) Ranges of survival (mo) 6.8-58.5 4.0-101.8 4.9-6.3 3.5-18.9 1.7-20.1 9.8-22.4 Liver, solitary (79) Liver, multiple (17) Locoregional except liver (106) Lung or pleura (18) Bone (5) Brain (2) Abdominal or chest wall (2) Peritoneal seeding (47) Supraclavicular lymph node (2) Multiple sites (11) 1.0-89.1 0.8-30.3 0.6-71.6 1.5-38.7 2.2-17.2 4.6-7.5 1.9-2.2 0.5-35.5 14.6-21.8 1.4-32.5 191