Assessing surgical resection in recurrent biliary tract cancer: International two-centre experience

The indications for surgical resection of recurrent biliary tract cancer (BTC) remain unclear, despite several reports.

We retrospectively analysed 353 patients who experienced recurrence after undergoing curative-intent resection of BTC at two high-volume centres. Patients were categorized into two groups: those who underwent surgical resection for recurrence (re-resection group) and those who did not (non-resection group). The clinicopathological characteristics and prognostic factors were compared.

Among the 353 patients who experienced recurrence after radical resection of BTC, 44 underwent surgical resection for recurrence. The median overall survival (OS) after recurrence was significantly longer in the re-resection group than in the non-resection group (45.6 months vs. 11.9 months, p < 0.001). A multivariable analysis identified age ≥70 years (p = 0.002), advanced primary tumour stage (pT3/T4) (p = 0.015), distant metastasis at initial surgery (p = 0.022), postoperative complications following initial surgery (p = 0.011), carbohydrate antigen 19-9 at recurrence ≧ 500 U/mL (p = 0.019), disease-free interval <12 months (p < 0.001), and non-surgical management for recurrence (p < 0.001) as independent risk factors for poor OS after recurrence. In the re-resection subgroup, gallbladder cancer (p < 0.001) and initial recurrence at sites beyond the liver (p = 0.013) were associated with worse OS.

Although recurrence after BTC surgery is generally associated with poor prognosis, carefully selected patients may drive significant survival benefits from recurrence. Patients with GBC or extrahepatic recurrence require particular caution in surgical decision-making.