title: Recurrence after resection with curative intent for distal cholangiocarcinoma.
abstract: BACKGROUND
  Few studies have been conducted on patterns of recurrence after resection for distal cholangiocarcinoma (DCC). The aim of this study was to investigate the incidence and pattern of recurrence after resection of DCC, and to evaluate prognostic factors for time to recurrence and recurrence-free survival (RFS).
  
  
  METHODS
  Patients who underwent pancreatoduodenectomy with curative intent for DCC between 2001 and 2010 at one of 30 hospitals in Japan were reviewed retrospectively, with special attention to recurrence patterns. The Cox proportional hazards model was used for multivariable analysis.
  
  
  RESULTS
  In the study interval, 389 patients underwent pancreatoduodenectomy for DCC with R0/M0 status. Recurrence developed in 213 patients (54·8 per cent). The estimated cumulative probability of recurrence was 54·3 per cent at 5 years. An initial locoregional recurrence occurred in 55 patients (14·1 per cent) and initial distant recurrence in 168 (43·2 per cent), most commonly in the liver. Isolated initial locoregional recurrence occurred in 45 patients (11·6 per cent). Independent prognostic factors for time to recurrence and RFS were perineural invasion (P = 0·001 and P = 0·009 respectively), pancreatic invasion (both P < 0·001) and lymph node metastasis (both P < 0·001). RFS worsened as the number of risk factors increased: the 5-year RFS rate was 70·6 per cent for patients without any risk factors, 50·3 per cent for patients with one factor, 31·8 per cent for those with two factors, and 13·4 per cent when three factors were present.
  
  
  CONCLUSIONS
  More than half of patients with DCC experienced recurrence after R0 resection, usually within 5 years. Perineural invasion, pancreatic invasion and positive nodal involvement are risk factors for recurrence.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Komaya
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Ebata
authors.affiliation: Department of Surgery, Yamashita Hospital, Ichinomiya, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Shirai
authors.affiliation: Department of Surgery, Handa City Hospital, Handa, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Ohira
authors.affiliation: Department of Surgery, The Gifu Prefectural Federation of Agricultural Cooperatives for Health and Welfare Kumiai Hospital, Takayama, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Morofuji
authors.affiliation: Department of Surgery, Nagoya Ekisaikai Hospital, Nagoya, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Akutagawa
authors.affiliation: Department of Surgery, Kasugai Municipal Hospital, Kasugai, Japan.
authors.forename: R
authors.initials: R
authors.lastname: Yamaguchi
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Nagino
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000209:etiology* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome