[Treatment of recurrent cancer after surgery for biliary malignancies]

Our strategy for recurrent tumor after surgical resection for biliary malignancies, especially for hilar cholangiocarcinoma, is described. One hundred and thirty-three patients with hilar cholangiocarcinoma underwent curative resection in our department until November, 1998, and recurrent carcinomas have been pointed out in 73 patients (54.9%). The site of recurrence was peritoneum (21 cases), liver (16 cases), pre-caval and retro-duodenal space (15 cases), hepatic hilum (11 cases), lymph node (9 cases), bone (6 cases), sinus tract of percutaneous transhepatic biliary drainage (PTBD) (5 cases) and so on. Surgical resection was applied to recurrent carcinomas after careful evaluation, and 9 patients underwent surgical resection of the recurrent tumor: sinus tract of PTBD in the abdominal and/or chest wall (4 cases), lymph node (2 cases), liver (1 case), hepaticojejunostomy (1 case) and duodenum (1 case). There were three hospital death patients. Other six patients survived for 16 months on an average (11-20 months) after surgery for recurrent tumor. PTBD for recurrent cancer at the hepatic hilum and gastrojejunostomy for local recurrence around the duodenum improved quality of life of patients. Radiation therapy for bone metastasis or local recurrence at the hepatic hilum was sometimes very effective. Effect of systemic or transarterial chemotherapy is still unknown.