Resection and/or Thermal Ablation for Recurrent Biliary Tract Cancer

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.