Roughly half of patients with distal cholangiocarcinoma (dCCA) experience recurrence even after R0 pancreaticoduodenectomy surgical resection, according to research published in the Annals of Hepato-Biliary-Pancreatic Surgery.

The study also found that patients with distant recurrence (DR) tend to have a more frequent recurrence pattern, with poorer survival than patients who have a locoregional recurrence (LRR). 

In the retrospective study, 109 of the 214 patients (50.9%) who underwent R0 resection experienced recurrence of their dCCA during the follow-up period.

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Patients who experienced recurrence were classified based on the location of the recurrence into either LRR or DR. In the 109 patients, those with DR were more common than those with LRR, 72 (66.9%) versus 37 (33.1%), respectively. The 5-year overall survival (OS) was compared between the DR, LRR, and patients with no recurrence. Results showed that overall survival was significantly different (P <.001) between the groups, with 98.7% of patients with no recurrence surviving, compared to only 40.5% of the LRR patients and 23.2% of the DR patients.

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The study also found that the group with DR was associated with a significantly earlier recurrence (14.1 months) than those with LRR (20.2 months; P =.001). Patients in the DR group also had lower numbers of harvested lymph nodes compared to the LRR group (15.1 vs. 21.6; P =.001).

Various prognostic factors were assessed for their ability to predict disease-free survival and overall survival. Multivariate analysis using the Cox proportional hazards model found that perineural invasion (P =.0444) and pathologic N2 stage cancer (P =.008) were independent prognostic factors for disease-free survival. In terms of overall survival, the study found that N1 and N2 stages of the cholangiocarcinoma were independent prognostic factors.

The research study was performed by an investigator at the CHA University School of Medicine in South Korea.


Kang I. Recurrence of distal cholangiocarcinoma after R0 resection: differing survival outcomes between the locoregional vs. distant recurrence. Ann Hepatobiliary Pancreat Surg. 2021;25(Suppl 1):S174. doi:10.14701/ahbps.BP-PP-4-6