Repeat resection for recurrent perihilar cholangiocarcinoma: A single-center retrospective study.

BACKGROUND: Systemic chemotherapy is considered the standard treatment for recurrent perihilar cholangiocarcinoma, whereas evidence regarding repeated surgical resection remains scarce. METHODS: We performed a retrospective analysis of our prospectively collected institutional database of all patients who underwent resection for recurrent perihilar cholangiocarcinoma. Statistical analysis included Kaplan-Meier analysis for survival data. RESULTS: Between 2008 and 2025, 9 patients underwent repeat resection for recurrent perihilar cholangiocarcinoma. Median time between first and second resection was 40 months (range: 21-85 months). Site of recurrence was locoregional/at the hepatic hilum (n = 3), distant intrahepatic (n = 4) and extrahepatic (n = 2). The residual tumor status was R0 in 7 patients and R1 in 2 patients. There was no 90-day mortality. Eight of nine patients developed a second tumor relapse after a median of 10 months (range 3-130 months) after repeat resection. In two patients, re-repeat resection was performed for a second recurrence in the liver. Median OS after repeat resection was 27 months with a 1-, 3-, and 5-year survival of 89%, 39%, 23% compared to 13 months and a 1-, 3-, and 5-year-survival of 54%, 12% and 0% after non-surgical management (P = 0.037). Two patients are alive without evidence of disease 50 and 194 months after first repeat resection. CONCLUSIONS: In carefully selected patients with recurrent perihilar cholangiocarcinoma, repeat resection is a technically challenging but feasible and safe treatment option which can potentially offer mid- and even long-term survival.