A Case which Underwent Pancretoduodenectomy for Recurrence in the Lower Bile Duct after Surgery for Hilar Cholangiocarcinoma

Abstract

69-year-old man underwent extended left hepatectomy for hilar cholangiocarcinoma in November 1999, and curability B resection was achieved. In May 2003, he was admitted for cholangitis that was improved by conservative therapy, but recurrence in the remnant bile duct of the pancreas was revealed, and he underwent a pancreatoduodenectomy curatively in July 2003 but he died of multiple liver metastases at the 20th postoperative month. We concluded that fragments originating from the fragile hilar cholangiocarcinoma growing papillary in the bile duct were seeded in the residual bile duct, although metachronous carcinogenesis in the biliary tract may also explain the pathogenesis. It has been reported that there is little opportunity for salvage surgical resection in recurrent cases after curative operation for hilar cholangiocarcinoma, and an atypical and aggressive procedure is often required, resulting in a poor prognosis. In 17 reported cases including our case in Japan since 1990, three patients (17%) died in hospital, 12 patients (70%) suffered recurrence after reoperation. Seven patients (41%) have survived for one year or more however, therefore surgical treatment for recurrence is an important current arm in the absence of other effective alternatives.