A Case of Resected Metachronous Hilar Cholangiocarcinoma after Pancreaticoduodenectomy for Distal Bile Duct Cancer

Abstract

A 72-year-old woman had undergone pancreaticoduodenectomy (PD) in our hospital for distal bile duct cancer (pT2N0M0, Stage IIA). A computed tomography image of the abdomen captured thirty months after the initial surgery revealed right intrahepatic bile duct dilatation and hilar bile duct stenosis. Endoscopic retrograde cholangiopancreatography revealed stenosis of the right hepatic duct, and adenocarcinoma was detected in the endoscopic biopsy sample. Based on the diagnosis of perihilar cholangiocarcinoma originating from the right hepatic duct, a right caudate lobectomy and a left biliary tract reconstruction were performed. The resected specimen revealed a tumor in the right hepatic duct. Histopathological diagnosis of the tumor was a well-differentiated adenocarcinoma (pT2bN0M0, Stage II) ; however, the surgical margin of the left hepatic duct was histologically positive (HM1, R1). The patient showed lymph node metastasis 11 months after the second surgery. She died of the disease, thirty-one months after diagnosis.