Abstract
Prognosis of gallbladder carcinoma patients with positive para-aortic lymph nodes is poor. We report a case of long-term survival in a patient with the above mentioned condition who underwent pancreaticoduodenectomy for residual metastatic lymph nodes. The patient was a 51-year-old man with gallbladder carcinoma who underwent cholecystectomy with wedge resection of the gallbladder bed. We found suspicious lymph nodes in the retro-pancreaticoduodenal area, which appeared to require pancreaticoduodenectomy for complete dissection. However, we abandoned pancreaticoduodenectomy and opted for observation after radiotherapy because para-aortic lymph node metastasis was observed. Although retro-pancreaticoduodenal lymph nodes progressively enlarged thereafter, no new metastatic lesions appeared. Therefore, we performed pancreaticoduodenectomy with residual metastatic lymph node dissection 4 years after the first surgery. Five years after the second surgery, the patient is in good health without any sign of recurrence. Immunohistochemical analysis revealed significant intratumoral infiltration of immune cells, suggesting that the antitumor immune response may be one of the factors influencing long-term survival in the patient.
