title: Survival of surgery for recurrent biliary tract cancer: a single-center experience and systematic review of literature.
abstract: BACKGROUND
  For recurrent biliary tract cancer, chemotherapy is the standard treatment. However, the efficacy of surgery is unknown. Here, the prognostic benefit of surgery for recurrent biliary tract cancer was investigated.
  
  
  METHODS
  Data of 206 patients who underwent surgery for biliary tract cancer between 2005 and 2015 were retrospectively analyzed. Of these, 107 recurrent patients were divided into two groups, surgery (n = 14) and non-surgery (n = 93) groups. In the latter group, 45 patients received chemotherapy and 48 received best supportive care.
  
  
  RESULTS
  Of the total 121 sites of recurrence, the liver was the most common (n = 41), followed by locoregional recurrence (n = 32) and lymph nodes (n = 18). Surgery was performed in the 14 patients with recurrence, comprising nine patients with intrahepatic cholangiocarcinoma, three with perihilar cholangiocarcinoma, one with distal cholangiocarcinoma and one with gallbladder carcinoma. Survival after recurrence was significantly better after surgery than after chemotherapy or best supportive care (38% vs. 5.3% vs. 0% at 3 years and 19% vs. 5.3% vs. 0% at 5 years; P < 0.0001). Multivariate analysis identified the residual status of the primary tumor (hazard ratio = 1.58, 95% confidence interval = 1.00-2.44; P = 0.047), time to recurrence ≥1 year (hazard ratio = 0.62, 95% confidence interval = 0.39-0.97; P = 0.037) and surgery for recurrence (hazard ratio = 0.32, 95% confidence interval = 0.14-0.62; P < 0.001) as independent prognostic factors.
  
  
  CONCLUSIONS
  Surgery for recurrent biliary tract cancer may prolong survival in patients with time to recurrence ≥1 year.
authors.affiliation: Division of Gastroenterological Surgery, Saitama Cancer Center, Saitama, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Miyazaki
authors.affiliation: Division of Gastroenterological Surgery, Saitama Cancer Center, Saitama, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kokudo
authors.affiliation: Division of Gastroenterological Surgery, Saitama Cancer Center, Saitama, Japan.
authors.forename: Katsumi
authors.initials: K
authors.lastname: Amikura
authors.affiliation: Division of Gastroenterological Surgery, Saitama Cancer Center, Saitama, Japan.
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Kageyama
authors.affiliation: Division of Gastroenterological Surgery, Saitama Cancer Center, Saitama, Japan.
authors.forename: Amane
authors.initials: A
authors.lastname: Takahashi
authors.affiliation: Department of Surgery, Clinical Sciences, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Ohkohchi
authors.affiliation: Division of Gastroenterological Surgery, Saitama Cancer Center, Saitama, Japan.
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Sakamoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001661:Biliary Tract Neoplasms / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D016019:Survival Analysis
keywords: biliary tract cancer; cholangiocarcinoma; gallbladder cancer; recurrence