Abstract
A 61-year-old woman who underwent pancreaticoduodenectomy (PD) for cancer of the middle bile duct in 2004 presented to our hospital because of general fatigue in 2011 after an about 7-year recurrence free period. Abdominal CT and MRI scans revealed multiple tumors in the posterior segment of liver, suggesting a possible presence of a tumor in the bile duct in the posterior segment. The patient was decided to undergo surgery with a suspicion of recurrence at the surgical stump of the bile duct after PD or cholangiocarcinoma. Considering that recurrence involving the surgical stump was probable, we performed extended right lobectomy of liver including the choledochojejunostomy. The histopathological specimen disclosed that the multiple tumors arisen in the hepatic posterior segment were all abscesses, and there was a tumor in the bile duct in the posterior segment neighboring the choledochojejunostomy. Since the tumor was away from the anastomosed site and most part of the tumor involved papillary portion of the lumen, we determined that the tumor was not recurrence at the anastomosed site but metachronous cholangiocarcinoma. The postoperative course was uneventful and the patient was discharged from the hospital on the 20th postoperative day. She has been recurrence free up to now.
We present this case of metachronous cholangiocarcinoma occurred 7 years after PD in which hepatic resection yielded favorable postoperative course, together with some bibliographic comments.
