Radical resection in patients with recurrent distal cholangiocarcinoma (DCC) may help improve prognosis in the selected patients, a recently published study in BMC Surgery revealed. Time to recurrence and single distant metastasis are considered essential factors for adequate resection in recurrent lesions in patients with DCC.

This study was conducted to assess the outcomes of resection of recurrent DCC and to evaluate the indications for surgical resection of recurrent lesions based on the prognostic factors of primary and recurrent DCC.

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The research team enrolled 115 patients who had undergone surgical resection for distal cholangiocarcinoma between January 2000 and December 2018 at Tokai University Hospital. The clinicopathological factors and prognosis of the primary and recurrent DCC were investigated for the leftover 101 patients.

Study findings suggest that 52 (51.5%) of 101 patients reported relapsed. Seven (13.5%) of those 52 patients underwent resection of recurrent lesions, while the remaining 45 (86.5%) underwent palliative therapy. The study reported no significant complications demanding therapeutic intervention after mastectomy.

Moreover, the overall survival in patients with recurrent lesion surgery was 83 months compared to 34 months in patients with no recurrent lesion surgery, suggesting that patients who had undergone surgery for recurrent lesions had a significantly better prognosis. Furthermore, multivariate analyses of the recurrent DCC showed that recurrence within one year was an independent predictor of the poor survival rate among the patients. Conclusively, resection of the recurrent lesions improved the prognosis.

Cholangiocarcinoma, a heterogeneous group of malignancies, accounts for 3% of all cancerous gastrointestinal diseases. Distal cholangiocarcinoma, a subtype of cholangiocarcinoma, accounts for 30% of all bile duct cancers. Surgical resection is reported to be the only curative treatment for DCC. However, because of the high recurrence rate and poor prognosis, more than 50% of cases recur within three years, and the 5-year survival rate is reported to be 18% to 54% for this disease.

“Although the number of patients was limited, the results suggested the efficacy of resection in recurrent lesions in selected patients. Time to recurrence and single distant metastasis is considered an important factor; however, the small number of relevant cases in this study makes it difficult to conclude which patients are best suited for the resection of recurrent lesions,” the study authors noted.

“This issue requires clarification with a multicenter, prospective study, considering patients’ backgrounds, such as the recurrence site and the number of metastases,” they added.

Chemotherapy is the preferred treatment option for recurrent biliary tract cancers. Besides, few reports have suggested that resectioning the recurrent lesions improves the prognosis, the authors noted.


Mashiko T, Ogasawara T, Masuoka Y, et. al. Indications for resectioning recurrent lesions in patients with distal cholangiocarcinoma based on prognostic factors: a single-institute retrospective study and brief literature review. BMC Surg. Published online December 12, 2022. doi: 10.1186/s12893-022-01879-3