A case of metachronous ampullary cancer treated by pancreatoduodenectomy two years after hepatic resection for perihilar cholangiocarcinoma

Abstract

A 59-year-old man was admitted for jaundice. Right hepatectomy was performed for perihilar cholangiocarcinoma. His serum CA 19-9 levels had gradually risen over the 2 years after the hepatectomy. PET-CT scan showed abnormal accumulation of fluorodeoxyglucose in the papilla of Vater, and endoscopy revealed enlargement and ulceration at this site. This lesion was diagnosed as adenocarcinoma on biopsy. The imaging findings indicated no recurrence of perihilar cholangiocarcinoma. We performed subtotal stomach-preserving pancreatoduodenectomy for the diagnosis of metachronous ampullary cancer. The patient is doing well at 5 years and 3 months after his first surgery, with no recurrence. Although it is rare to perform surgery for metachronous biliary cancer that develops after hepatectomy for perihilar cholangiocarcinoma, it is important to examine surgical indications to determine whether a curative operation may be possible.