2018 Volume 32 Issue 2 Pages 256-262
A 74-year-old woman underwent subtotal stomach-preserving pancreaticoduodenectomy for distal cholangiocarcinoma. The postoperative histopathological diagnosis was Bd tub1 T3a N1 (#17b) M0 DM0 HM0 EM0 PV0 A0 R0 stage IIB (General Rules for Clinical and Pathological Studies on Cancer of the Biliary Tract, 6th Edition). Adjuvant chemotherapy with TS-1 80 mg/m2 (14-day course, 7 days between courses) was administered for 1 year. Four years and 8 months later, an elevated CA19-9 result (67U/mL, range: 0-37U/mL) prompted further tests. The test results indicated primary intrahepatic cholangiocarcinoma; therefore, surgery was planned. Laparotomy was performed at the site of the previous Benz incision. The right lobe was turned and S7 partial hepatectomy was performed without using the Pringle maneuver.
Although this hepatectomy followed a pancreaticoduodenectomy, it was performed safely. The postoperative course was good and the patient was discharged 8 days after surgery. The resected liver (S7) tumor was 0.7cm and diagnosed with Well differentiated Tubular adenocarcinoma T1 N0 M0 R0 stage I (General Rules for Clinical and Pathological Study of Primary liver Cancer The 6th Edition) histopathologically.
The patient remains relapse-free and is being seen on an outpatient basis.
Therefore, it is important to perform hepatectomy as the initial therapy.
Heterochronic intrahepatic cholangiocarcinoma after distal cholangiocarcinoma resection is uncommon, with only 7 reported, including the present case. Despite the pathologic diagnosis, long-term survival is possible because resection could be performed.
