Late recurrence after surgery for cholangiocarcinoma:implications for follow-up?

BACKGROUND:Biliary tract cancer is uncommon,but has a high rate of early recurrence and a poor prognosis. There is only limited information on patients surviving more than 5 years after resection. METHODS:We report a patient who developed recurrence 8 years after resection of cholangiocarcinoma.Descriptions of late recurrence after excision of cholangiocarcinoma are reviewed. RESULTS:Few long-term survivors with biliary tract cancer have been reported.The survivors tend to have well differentiated or papillary tumors.The present case had no recurrence for 8 years despite poor prognostic factors including poor differentiation,invasion through the muscle wall and perineural invasion.It has been suggested that tumor cells left after the first operation grow and present as late recurrence.There is a need to differentiate a new primary and field change from recurrence of the previous tumor. CONCLUSIONS:Long-term follow-up after resection of cholangiocarcinoma is needed because late recurrence after 5 years occurs.The mortality rate between 5 and 10 years after resection of cholangiocarcinoma ranges from 6%to 43%in different series.Early detection of local recurrence may give an opportunity for further surgical resection.

Late recurrence of localized pure seminoma in prostate gland:A case report

BACKGROUND Late relapses of early-stage germ cell tumors are rare.Most patients(-85%)with stage I seminoma are cured by radical orchiectomy.The detection of late relapse is challenging given the relative rarity of this phenomenon,and the fact that patients who have completed surveillance are usually not undergoing regular oncologic workup nor imaging.While many treatment options do exist for a patient with late relapse of seminoma,surgery is typically the mainstay as these tumors are generally thought to be more chemo-resistant.CASE SUMMARY In this article,we describe the management of a patient with an early-stage pure seminoma who was subsequently identified to have a recurrence two decades later.We provide a review of the literature not only focused on clinical factors and biology,but also the management of late recurrences specifically in pure seminoma and in prostate gland.CONCLUSION There is a paucity of data and treatment recommendations for this clinical entity,and a multidisciplinary approach emphasizing subspecialty expert consultation and patient education is imperative.

Predictors of early and late hepatocellular carcinoma recurrence

Hepatocellular carcinoma(HCC)is the most frequent liver neoplasm,and its incidence rates are constantly increasing.Despite the availability of potentially curative treatments(liver transplantation,surgical resection,thermal ablation),long-term outcomes are affected by a high recurrence rate(up to 70%of cases 5 years after treatment).HCC recurrence within 2 years of treatment is defined as“early”and is generally caused by the occult intrahepatic spread of the primary neoplasm and related to the tumor burden.A recurrence that occurs after 2 years of treatment is defined as“late”and is related to de novo HCC,independent of the primary neoplasm.Early HCC recurrence has a significantly poorer prognosis and outcome than late recurrence.Different pathogenesis corresponds to different predictors of the risk of early or late recurrence.An adequate knowledge of predictive factors and recurrence risk stratification guides the therapeutic strategy and post-treatment surveillance.Patients at high risk of HCC recurrence should be referred to treatments with the lowest recurrence rate and when standardized to combined or adjuvant therapy regimens.This review aimed to expose the recurrence predictors and examine the differences between predictors of early and late recurrence.

Late retroperitoneal recurrence of hepatocellular carcinoma 12 years after initial diagnosis

Hepatocellular carcinoma (HCC) is an aggressive tumor with poor long-term prognosis.Here,we present an unusual patient with a solitary recurrence of HCC in the right kidney 12 years after the initial diagnosis.This illustrates the importance of considering late recurrence in patients with a history of HCC and the management of these metastases.

Characteristics of gastric cancer recurrence five or more years after curative gastrectomy

Objective： To investigate the characteristics of recurrences that occurred 5 or more years after curative resection for gastric cancer.Methods： We analyzed recurrences among 1,299 patients with gastric cancer who underwent curative operations at the Department of Surgery, Inje University Seoul Paik Hospital between September 1998 and December 2002. Recurrences were classified as within 2 years （early）, 2-5 years （intermediate）, and more than 5 years （late） after gastrectomy. The clinicopathologic findings of the patients with late recurrence were compared with those of patients in the other two recurrence groups, with special reference to the patterns of recurrence. Both univariate and multivariate analyses were performed, incorporating factors such as operation type, T-stage, N-stage, stage, lymphatic invasion, neural invasion, histology, tumor size, and recurrence site.Results： At the time of last follow-up, recurrence occurred in 266 （20.5%） patients. Recurrence times were classified as 〈2 years （182 patients）, 2-5 years （61 patients）, or 〉5 years （23 patients）. The late recurrence rate was 8.6%. The occurrence of recurrence 〉5 years after gastrectomy was significantly correlated with age, operation type, T-stage, N-stage, stage, lymphatic invasion, neural invasion, histology, tumor size, location and recurrence site （P〈0.05）. The main recurrence patterns in the 23 patients with late recurrence were locoregional metastasis （10 patients, 43.5%）, peritoneal seeding （8 patients, 34.8%）, hematogenous metastasis （2 patients, 8.7%）, and multiple metastasis （3 patients, 13.0%）. A multivariate analysis showed that larger tumor size and younger age were independent prognostic factors for late recurrence. Additionally, locoregional and peritoneal recurrences were significantly more common than hematogenous recurrences. Conclusions： Although late recurrence was uncommon, younger age and larger tumor size were associated with high risk. Follow-up surveillance is recommended for locoregional and peritoneal metastasis.

Isolated liver metastasis detected 11 years after the curative resection of rectal cancer:A case report

BACKGROUND The duration of surveillance after curative resection of colorectal cancer(CRC)is generally 5 years.The overall incidence of recurrence more than 5 years after surgery for CRC in Japan has been reported to be 0.6%.Moreover,it is rare for CRC to have metachronous liver metastasis more than 10 years after surgery.Here,we present a case of liver metastasis detected 11 years after the curative resection of rectal cancer.CASE SUMMARY A 72-year-old man was referred to our hospital after a liver tumor was detected by abdominal ultrasonography at another hospital.He had undergone surgery for rectal cancer 11 years previously.Contrast-enhanced computed tomography(CT)showed a tumor with a diameter of approximately 8 cm in the posterior segment,which was weakly and gradually enhanced.18F-fluorodeoxyglucose-positron emission tomography/CT showed an abnormally high uptake on the tumorous lesion,which showed that the tumor appeared to spread convexly along the intrahepatic bile ducts.Intrahepatic cholangiocarcinoma was therefore diagnosed,and he had an extended right posterior sectionectomy and regional lymph node dissection.Histopathological examination showed that the tumor was a moderately differentiated adenocarcinoma and showed the same pathological characteristics as the rectal cancer.Immunohistological examination showed that the cancer cells of both the liver tumor and rectal cancer were positive for cytokeratin(CK)20 and weakly positive for CK 7.These findings were consistent with the liver metastasis from the rectal cancer.CONCLUSION It is possible that a liver tumor is metastatic in a patient with a previous history of CRC,even if it was more than 10 years earlier.

Asynchronous abdominal wall and sigmoid metastases in clear cell renal cell carcinoma: A case report and literature review

Sigmoid metastasis of renal cell carcinoma(RCC)is very rare.Herein we report a case of pathologically proven asynchronous abdominal wall and sigmoid metastases after a right nephrectomy.An 84-year-old man underwent right radical nephrectomy for clear cell renal cell carcinoma(ccRCC)13 years ago.Solitary contralateral abdominal wall metastasis was found for left abdominal mass 9 years after nephrectomy.The man experienced melena underwent resection of sigmoid colon tumor in February,2016.The postoperative pathological examinations revealed that the tumors were metastases of ccRCC.Recurrence more than 5 years after nephrectomy has been accepted as late recurrence by the majority of urologists now.Late recurrence is one of the specific biological behaviors of RCC.Asynchronous late recurrence of abdominal wall and sigmoid metastases in ccRCC has not been reported before.When patients have sigmoid mass after nephrectomy for RCC,doctors may consider the possibility of late recurrence.

Risk of early hepatocellular carcinoma recurrence following liver resection: arbitrary specification or possible target to improve outcome?

Data from the literature favour liver transplantation(LT)as best curative-intent treatment in patients with early-stage hepatocellular carcinoma(HCC)arising from cirrhosis,as this approach targets both malignancy and the underlying cancerogenic pathomorphology.By strictly adhering to well-defined morphometric tumor burden limits,such as the Milan criteria,excellent recurrence-free survival(RFS)rates beyond 70%at 5 years may be achieved after LT.However,growing donor liver shortage has significantly increased waiting times and thereby risk of tumor-related dropout from the waiting list,ultimately resulting in inferior survival probability.In recent years,this critical situation further aggravated by growing evidence that beyond Milan patients may also benefit from LT,when being successfully downstaged by neoadjuvant locoregional interventions like transarterial chemoembolization(TACE)or radiofrequency ablation(RFA)(1).Therefore,even though being associated with an extraordinary risk of HCC recurrence accounting for 50%to 70%,upfront liver resection(LR)still represents the preferred surgical procedure in patients with resectable tumor stage,especially in those who do not suffer from severe portal hypertension.