*HPB oncology benchmarks for survival, recurrence, disease biology, and clinical decision-making.* > [!info] Core Principle > Experienced surgeons carry mental benchmarks that help frame prognosis, interpret outcomes, guide tumor board discussions, and counsel patients. > > These numbers are not absolutes — they are anchors for clinical reasoning. > > The goal of carrying these numbers is not memorization — it is building intuition for prognosis, treatment strategy, and patient counseling. --- ### Quick Reference Table | Disease | Number to Carry | Clinical Meaning | | -------------- | ------------------------------ | ------------------------------ | | PDAC | 70–80% recur | Systemic disease early | | Ampullary | 40–60% 5-year OS | Subtype determines biology | | iCCA | 50–70% recur | R0 does not overcome biology | | pCCA | 50–70% recur | Margins/nodes drive outcomes | | Gallbladder | 50–70% recur | Aggressive systemic disease | | HCC resection | 50–70% recur | Tumor + liver biology | | HCC transplant | 10–20% recur | Selection changes outcomes | | CRLM | 60–70% recur, 50–60% 5-year OS | Potentially curable metastases | | NELM | >60–80% 5-year OS | Durable control paradigm | --- ### Pancreatic Ductal Adenocarcinoma (PDAC) **After resection:** - recurrence: **~70–80%** - median time to recurrence: **12–18 months** - majority recur within **2 years** - 5-year OS: **~20–30% historically** What number do you carry? > Even after “curative” surgery, most patients recur. **Clinical intuition:** - systemic disease early - distant recurrence > isolated local recurrence --- ### Ampullary Adenocarcinoma **After resection:** - recurrence: **~30–50%** - 5-year OS: **~40–60%** What number do you carry? > Histology matters. **Clinical intuition:** - intestinal subtype → favorable biology - pancreatobiliary subtype → behaves more like PDAC --- ### Intrahepatic Cholangiocarcinoma (iCCA) **After resection:** - recurrence: **~50–70%** - median time to recurrence: **12–24 months** - majority recur within **2 years** - 5-year OS: **~25–40%** What number do you carry? > Roughly half recur within 2 years. **Clinical intuition:** - high recurrence despite R0 resection - liver recurrence common --- ### Perihilar Cholangiocarcinoma (pCCA) **After resection:** - recurrence: **~50–70%** - median time to recurrence: **1–2 years** - 5-year OS: **~30–40%** What number do you carry? > Complete resection is necessary but not sufficient. **Clinical intuition:** - nodal disease and margins dominate prognosis --- ### Distal Cholangiocarcinoma (dCCA) **After resection:** - recurrence: **~40–60%** - 5-year OS: **~30–50%** What number do you carry? > Better biology than pancreatic cancer despite the same operation. **Clinical intuition:** - recurrence risk remains significant - behaves between ampullary and PDAC --- ### Gallbladder Cancer **After resection:** - recurrence: **~50–70%** - median time to recurrence: **12–18 months** - most recur within **2 years** What number do you carry? > Early recurrence is common. **Clinical intuition:** - aggressive systemic biology - liver, peritoneum, and nodal recurrence common --- ### Hepatocellular Carcinoma (HCC) **After Resection** - 5-year recurrence: **~50–70%** - 5-year OS: **~50–70%** in selected patients What number do you carry? > Recurrence is expected; timing tells the story. **Clinical intuition:** - early recurrence (<2 years) → tumor biology - late recurrence (>2 years) → new primary / field defect **After Transplant** - recurrence: **~10–20%** - most recurrence occurs within **2 years** **Clinical intuition:** - transplant treats both tumor and liver --- ### Colorectal Liver Metastases (CRLM) **After liver resection:** - recurrence: **~60–70%** - majority recur within **2–3 years** - 5-year OS: **~50–60%** What number do you carry? > Recurrence does not equal failure. **Clinical intuition:** - classic [[Colorectal Liver Metastases|oligometastatic paradigm]] - repeat resection/local therapy can still lead to cure --- ### Neuroendocrine Liver Metastases (NELM) **After liver-directed therapy:** - recurrence: **common** - recurrence may occur years later - 5-year OS: **>60–80%** in selected patients What number do you carry? > Disease control matters more than recurrence. **Clinical intuition:** - indolent biology - chronic disease-management paradigm