treatment. 5-fluorouracil-based chemotherapy and radio- therapy (44-54 Gy) were generally applied, although there were differences in the dose and treatment period accord- ing to the individual. Types of treatment for recurrence 　Patients were routinely followed in the outpatient de- partment with CA 19-9 levels and abdominal con- trast-enhanced computed tomography (CT) every 3 to 6 months. Recurrence was highly suspected when the level of serum CA 19-9 increased, and confirmed with CT with or without 18F-fluorodeoxyglucose positron emission to- mography by experienced radiologists. It was classified as one of followings; intrahepatic recurrence, locoregional recurrence except liver, distant metastasis. The inclusion criteria for RFA generally followed the in- dications for hepatocellular carcinoma; ＜3 tumor lesions with a maximum diameter ＜3 cm, single nodular lesions with a maximum diameter ＜5 cm, no major vessel or bile duct involvement, and no uncorrectable coagulopathy [25]. The technical effectiveness was verified with a CT af- ter 1 month with no residual unablated tumors. Further hepatic resection was considered according to the anatomic location, size, and number of lesions when RFA could not be performed. Metastasectomy was consid- ered for metastatic lesions of the abdominal wall, chest wall, peritoneum, and solitary pulmonary nodules. Pylorus-preserving pancreaticoduodenectomy or Whip- ple’s procedure was performed to treat locoregional re- currence after segmental bile duct resection for extra- hepatic cholangiocarcinoma. Statistical analysis A Student’s t test (two-tailed) and χ2 test or Fisher’s ex- act test were used to analyze continuous or categorical var- iables, respectively. Overall survival was calculated using the Kaplan-Meier method and differences in survival were determined using the log-rank test. Prognostic factors on overall survival were indentified using multivariate Cox proportional hazards models. Statistical calculations were performed using SPSS ver. 16.0 (SPSS Inc., Chicago, IL, USA). P-values ＜ 0.05 were considered statistically significant. thesurgery.or.kr Surgical treatments for recurrent cholangiocarcinoma RESULTS Demographics The median follow-up period was 21.8 months (range, 1.8 to 153.0 months) and the number of patients was 27 and 289 in group A and B, respectively. There were no stat- istical differences in gender, age and pre-operative carci- noembryonic antigen and CA 19-9 levels. In addition, tu- mor size, location, differentiation, radicality, the ratio of lymph node metastasis, tumor staging and time-to-re- currence did not have significant differences, except the rate of patients receiving adjuvant concurrent chemo- radiotherapy, which was shown to be statistically higher in group A (P = 0.037, Table 1). Recurrence after surgical resection 5, 9 and 13 patients underwent surgical treatment for re- Table 1. Demographics and clinicopathologic variables Group A(n = 27) Group B (n = 289) P-value Gender (M:F), n (%) 14 (51.9):13 (48.1) 185 (93.0):104 (88.9) 0.218 Age, mean (range) 58.3 (45-69) 60.4 (31-79) 0.255 Tumor location, 0.720 n (%) Intrahepatic 5 (18.5) 69 (23.9) Perihilar 9 (33.3) 69 (23.9) Extrahepatic 13 (48.1) 151 (52.2) Differentiation, 0.889 n (%) Well 2 (8.3) 33 (12.4) Moderate 13 (54.2) 144 (54.1) Poorly 9 (37.5) 87 (32.7) Undifferentiated 0 (0) 2 (0.8) Tumor staging 0.280 (AJCC 7th), n (%) I (IA, IB) 7 (30.4) 36 (14.8) II (IIA, IIB) 12 (52.2) 134 (55.1) III (IIIA, IIIB) 3 (13.0) 48 (19.8) IV (IVA, IVB) 1 (4.3) 25 (10.3) Radicality, n (%) 1.000 R0 25 (92.6) 258 (89.3) R1 2 (7.4) 31 (10.7) Adjuvant CCRT, 22 (81.5) 172 (59.5) 0.037 n (%) Time-to-recurrence 15.0 (1.3-133.4) 10.1 (1.2-120.3) 0.118 (mo), median (range) AJCC, American Joint Committee on Cancer; CCRT, concurrent chemoradiotherapy. 189