Abstract
A 68-year-old man underwent pancreaticoduodenectomy for middle and lower extrahepatic cholangiocarcinoma in September, 2004. The histopathological diagnosis using an intraoperative frozen section revealed that cancer cells were present at the cut end of the right hepatic duct, although two additional resections of the hepatic duct were performed. Concomitant right hepatectomy was not performed because of concerns about postoperative coronary insufficiency. On pathology, cancer cells were confirmed at the epithelium of the hepatic duct on the hepatic side. A total of 50 Gy irradiation was applied around the anastomosis of the bile duct and the jejunum as adjuvant therapy. Six years later, the patient died due to sepsis caused by MRSA cholangitis and liver failure ; until that time, he had had an uneventful course without any evidence of recurrence. At autopsy, a recurrence at the anastomotic site was found. This case suggests that a patient with a positive surgical margin at the cut end of the hepatic duct can survive for a considerably long period of time when the finding is limited to the epithelial layer of the bile duct. At the same time, it is also important to note that careful long-term follow-up is necessary even in these types of patients because of the possibility of late recurrence.
