Sun Choon Song, et al. metastases were more common than locoregional recur- rence after R0 resection in patients with perihilar cholan- giocarcinoma. The 5-year overall survival rate after surgical resection of cholangiocarinoma is reported to be 5 to 40%, and the median overall survival time and median recurrence-free survival time is 27 to 33 and 9 to 27 months, respectively [6-8,10,13,15,18-20]. Many published series have reported the risk factors for poor survival and recurrence; peri- neural invasion via lymphatic pathway and the proximity to the peripheral nerve plexus, presence of lymph node metastasis, poor differentiation, higher T stage, positive surgical resection margin and high level of carbohydrate antigen (CA) 19-9 [12,15,17,19-21]. The recurrence sites vary from local or locoregional recurrence in abdominal cavity to distance metastasis including abdominal or chest wall, skeletal muscles, lung, bone or brain [1,6,5,22,23]. Repeated hepatic resection for large, resectable tumors or radiofrequency ablation (RFA) for several small nod- ules have demonstrated their effectiveness on survival for the treatment of recurrent intrahepatic cholangiocar- cinoma in some series [17,18,24]. However, there is no large-scale series to verify benefi- cial effects in terms of survival through surgical treat- ments including other types of recurrent cholangiocar- cinomas. Thus, we attempted to identify whether or not there is a survival benefit to patients with recurrent chol- angiocarcinoma who had undergone surgical resection with curative intent according to the recurrent sites and the types of resection. METHODS Study patients Nine hundred forty-nine patients who underwent sur- gical treatment for cholangiocarcinoma in a single in- stitute between May 1995 and July 2010 were reviewed ret- rospectively based on electronic medical records with pathologic reports. They proved to be primary adeno- carcinomas pathologically arising from the bile duct epi- thelium. With the exception of 28 patients who had pallia- tive resection, 921 patients underwent curative-intent sur- 188 gical resection (R0 = 830, R1 = 91). Cholangiocarcinoma was classified according to the tu- mor location according to preoperative radiologic and fi- nal pathologic findings, which included intrahepatic (n = 226), perihilar (n = 222), and extrahepatic (n = 474). Cholan- giocarcinoma of gallbladder was not included in this series. 74, 78 and 164 patients had recurrent diseases dur- ing the study period, respectively. These 316 patients were divided into the following 2 groups: patients who under- went surgical resection for recurrence (group A) and pa- tients who were not treated (group B). Initial procedures and managements To the patients with intrahepatic cholangiocarcinomas, anatomic liver resection, including segmentectomy, hemi- hepatectomy, extended hemi-hepatectomy, or tri-sectio- nectomy (with or without caudate lobectomy) were pri- marily considered. Wedge resection was also considered for small tumors located at the liver dome. Variable proce- dures, such as major hepatectomy with bile duct resection, hepatopancreaticoduodenectomy, pancreaticoduodenec- tomy, segmental bile duct resection, or liver transplan- tation were performed for perihilar cholangiocarcinoma according to Bismuth-Corlette type, tumor location and degree of infiltration. Finally, segmental bile duct re- section or pancreaticoduodenectomy was primarily con- sidered for extrahepatic cholangiocarcinoma based on the location of the tumor (upper-, middle-, and lower-third). Hepatopancreaticoduodenectomy was applied to the pa- tient with widespread cholangiocarcinoma and suspected invasion to the hepatoduodenal ligaments considering the medical condition of the patient. Routine frozen-sectional biopsy of ductal resectional margin was carried out to confirm microscopic extension during surgery. When the proximal or distal margin was proved to be tumor positive, additional resection of bile or hepatic ducts was performed. The regional lymph nodes in the hepatoduodenal ligament, peri-pancreatic, celiac, and along the common hepatic artery were dissected, but the degree of lymph node dissection was determined by the attending surgeon. If the pathologic evaluation re- vealed lymph node metastasis or positive resection mar- gins, the patient was recommended to receive adjuvant thesurgery.or.kr