Characteristics of late recurrences after hepatectomy for perihilar cholangiocarcinoma: a single‑center cohort study

Cancer research · Cholangiocarcinoma

The presence of pathological perineural invasion is significantly associated with late recurrence of perihilar cholangiocarcinoma.

Surgical resection is the only curative treatment for perihilar cholangiocarcinoma (pCCA); however, the majority of patients experience postoperative recurrence. While recurrence typically occurs within five years after surgery, recurrence after prolonged relapse‑free survival has been occasionally observed. This study aimed to investigate the clinicopathological factors associated with late recurrence of pCCA. Within a single–center cohort of 258 consecutive patients who underwent radical hepatectomy for pCCA between 1996 and 2019, nine patients (3.4%) experienced recurrence more than five years after surgery. Late recurrence was defined as recurrence occurring more than five years after surgery. Clinicopathological characteristics of late recurrence were analyzed and compared with those of patients who remained recurrence‑free for over 12 years (no‑recurrence group, n=14). Local recurrence was the most common after late recurrence, followed by liver metastasis. Chemotherapy was the primary treatment after recurrence, with surgical resection performed in two cases. The late‑recurrence group exhibited significantly higher rates of pathological perineural invasion (p=0.016) compared with the no‑recurrence group. All late‑recurrence patients demonstrated positive perineural invasion. These findings suggest that pathological perineural invasion is significantly associated with late recurrence of pCCA, providing important insights for long‑term follow‑up and management of pCCA patients.

Perineural invasion is a well‑known adverse prognostic factor for early recurrence in pCCA; this study demonstrates that it also drives late recurrence, underscoring the need for aggressive surveillance and potential adjuvant strategies in patients with this histopathologic feature.

Evidence level: Sejtvonalas. Laboratóriumi sejtekben vizsgálták.

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