J Korean Surg Soc 2011;81:187-194 http://dx.doi.org/10.4174/jkss.2011.81.3.187 ORIGINAL ARTICLE JKSS Journal of the Korean Surgical Society pISSN 2233-7903ㆍeISSN 2093-0488 Survival benefits of surgical resection in recurrent cholangiocarcinoma Sun Choon Song, Jin Seok Heo, Dong Wook Choi, Seong Ho Choi, Woo Seok Kim, Min Jung Kim Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Purpose: Attempt to identify the beneficial effects associated with surgical procedures on survival outcome of patients with recurrent cholangiocarcinoma. Methods: 921 patients diagnosed with cholangiocarcinoma underwent surgical resection with curative intent in a single institute during the last 15 years. Patients with recurrent disease were divided into two groups according to whether surgical procedures were performed for the treatment of recurrence. Clinicopathologic variables, rang- es of survival based on sites of recurrence, and types of treatment were analyzed retrospectively. Results: The median fol- low-up period was 21.8 months and 316 (34.3%) patients had recurrence. 27 (group A) patients with recurrent disease were treated surgically and 289 patients (group B) were not treated. Liver resection, metastasectomy, pancreaticoduodenectomy, partial pancreatectomy, and regional lymph node dissection were performed on the patients in group A. The overall survival rate was statistically higher in group A (P = 0.001). Among the surgical procedures, resection of locoregional recurrences (except liver) in abdominal cavity (4.0 to 101.8 months vs. 0.6 to 71.6 months) and metastasectomy of abdominal or chest wall (3.5 to 18.9 months vs. 1.9 to 2.2 months) showed remarkable differences with respect to the range of survival. Conclusion: Better survival outcomes can be expected by performing surgical resection of locoregional recurrences (except liver) in ab- dominal cavity and abdominal or chest wall metastatic lesions in recurrent cholangiocarcinoma. Key Words: Recurrence, Range of survival, Cholangiocarcinoma, Radiofrequency ablation INTRODUCTION Cholangiocarcinoma is the second most common pri- mary hepatobiliary malignancy originating from the epi- thelium of the intrahepatic, perihilar, or extrahepatic bile ducts, with the frequencies of 5 to 30%, 40 to 50%, and 20 to 30%, respectively [1-5]. The incidence of intrahepatic chol- angiocarcinoma is increasing worldwide, especially in Asia, while the incidence of extrahepatic cholangiocar- cinoma is somewhat stable or declining [6-11]. Surgical re- section remains the only curative treatment option for cholangiocarcinoma, but most patients are far advanced at the time of presentation, which leads to a poor survival outcome [12-16]. In addition, spreading widely through bile ductules and extensive invasion to adjacent organs, cholangiocarcinoma has frequent locoregional or distant recurrences via lymphatic chains or hematogenous meta- stasis [4,5,12,17,18]. Kobayashi et al. [19] reported distant Received April 11, 2011, Revised May 22, 2011, Accepted May 31, 2011 Correspondence to: Jin Seok Heo Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea Tel: ＋82-2-3410-0262, Fax: ＋82-2-3410-6980, E-mail: Jinseok.heo@samsung.com cc Journal of the Korean Surgical Society is an Open Access Journal. All articles are distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright © 2011, the Korean Surgical Society