Resection and/or Thermal Ablation for Recurrent Biliary Tract Cancer

Research Article

Austin J Surg. 2017; 4(2): 1098.

Resection and/or Thermal Ablation for Recurrent Biliary Tract Cancer

Ikuta S*, Aihara T, Nakajima T and Yamanaka N

Department of Surgery, Meiwa Hospital, Japan

*Corresponding author: Shinichi Ikuta, Department of Surgery, Meiwa Hospital, Agenaruo 4-31, Nishinomiya, Hyogo 663-8186, Japan

Received: January 17, 2017; Accepted: February 21, 2017; Published: February 24, 2017


Aim: Repeat resection of recurrent Biliary Tract Cancer (BTC) is possible in a limited number of patients, with thermal ablation being an alternative for small hepatic recurrences. The aim of this study was to investigate the beneficial effect of these interventions on survival in patients with recurrent BTC.

Methods: One hundred and six recurrent BTC patients were divided a group of patients who received intervention (surgical resection and/or thermal ablation) for recurrence (group 1, n=26) and another group who did not (group 2, n=80). The outcome of both groups was investigated retrospectively.

Results: There were no significant differences between the two groups with respect to demographic data, underlying pathology, primary tumor stage and initial disease-free interval. In group 1, hepatic recurrence was most common (n=24), followed by locoregional recurrence (n=13) and peritoneal seeding (n=7). A total of 41 interventions were performed in group 1. Post-recurrence survival was significantly better in group 1 than in group 2 (median: 19.4 vs. 10.5 months; p<0.05). An initial disease-free interval =2 years, absence of macroscopic residual tumor after initial intervention and two or more interventions were significant predictors of better survival after intervention. Overall survival after resection of the primary tumor was more favorable in group 1 than group 2, but the difference was not significant (median 44.3 vs. 30.7 months; p=0.07).

Conclusion: Repeat resection and/or thermal ablation can be valuable therapeutic options that achieve significant prolongation of post-recurrence survival in selected patients with recurrent BTC.

Keywords: Secondary surgery; Thermal ablation; Radio frequency ablation; Biliary tract cancer; Recurrence; Recurrent BTC


Biliary Tract Cancer (BTC), including cholangiocarcinoma, gallbladder carcinoma and ampullary carcinoma, has a poor prognosis with a 5-year survival rate of only 20.2% in Japan [1]. Complete surgical resection is currently the only curative therapy for BTC. However, even if radical resection is performed, early recurrence (either locoregional or metastatic) occurs in a considerable proportion of patients. Management of recurrent BTC is challenging because the disease is often aggressive and there is a lack of effective therapy. Although chemotherapy or radiotherapy is usually given as palliative treatment to improve symptoms and extend survival [2-4], the results are unsatisfactory. A few studies have explored the outcome of secondary surgery or thermal ablation for recurrent BTC [5-8], but there is no consensus regarding the role, indications and limitations of such treatment. In this retrospective study, we investigated the influence of resection and/or thermal ablation on survival in patients with recurrent BTC.

Patients and Methods

Between January 2003 and December 2015, 196 consecutive patients with BTC (including intrahepatic cholangiocarcinoma) underwent surgical resection at our institute. Of the 173 patients who had R0 or R1 resection, 106 (61%) developed recurrence during a mean follow-up period of 39.9 months (range: 1-155 months). Among them, 26 patients underwent repeat resection and/or thermal ablation to treat the recurrent tumor (group 1), whereas the remaining 80 patients did not (group 2). In group 1, imaging studies performed following treatment-whether primary tumor resection, post-operative adjuvant chemotherapy or palliative chemotherapy for recurrent disease-revealed that the recurrent tumor was potentially resectable without any signs of aggressive growth or widespread disease. Thermal ablation (microwave or Radiofrequency Ablation: RFA) was performed alone or in combination with hepatic resection for small (=3 cm) central hepatic recurrences. Patients who were poor candidates for surgery were often treated by percutaneous RFA. When thermal ablation was performed in a patient with entero-biliary anastomosis, oral prophylaxis with levofloxacin (500 mg daily) was started from 5 days before the procedure and continued for a total of 7 days to reduce the risk of liver abscess. Survival outcomes of each group were investigated by reviewing the medical records.


Categorical variables were compared by the chi-square test or Fisher’s exact test. Survival analysis was performed using Kaplan- Meier estimation and the log-rank test. Prognostic factors were identified by using multivariate Cox proportional hazards models. All statistical analyses were performed with EZR (Saitama Medical Center, Jichi Medical University, Saitama, Japan), which is a graphical user interface for R (The R Foundation for Statistical Computing, Vienna, Austria) and p<0.05 was considered significant.


Characteristics of the two groups

There were no significant differences between the groups with respect to demographic data, underlying pathology and primary tumor stage. The proportion of patients receiving chemotherapy also did not differ between the groups. Recurrence was classified as hepatic recurrence, locoregional recurrence (lymph node metastasis, perineural invasion or remnant bile duct recurrence), peritoneal seeding or other distant metastasis. In group 1, the most common type of recurrence was hepatic recurrence (n=24), followed by locoregional recurrence (n=13) and peritoneal seeding (n=7). The Initial Disease-Free Interval (IDFI) after surgery for primary BTC was 13.2 months in group 1 and 9.5 months in group 2, with no significant difference of IDFI between the two groups (Table 1).