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Japanese Journal of Clinical Oncology Advance Access originally published online on February 14, 2006
Japanese Journal of Clinical Oncology 2006 36(3):176-179; doi:10.1093/jjco/hyi232
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© 2006 Foundation for Promotion of Cancer Research

Case Reports

Extended Right Hemihepatectomy as a Salvage Operation for Recurrent Bile Duct Cancer 3 Years after Pancreatoduodenectomy

Taizo Hibi1, Yoshihiro Sakamoto1, Naobumi Tochigi1, Hidenori Ojima2, Kazuaki Shimada1, Tsuyoshi Sano1 and Tomoo Kosuge1

1 Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo and 2 Pathology Division, National Cancer Center Research Institute, Tokyo, Japan

For reprints and all correspondence: Yoshihiro Sakamoto, Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan. E-mail: yosakamo{at}ncc.go.jp

Received October 12, 2005; accepted November 29, 2005

Salvage surgery for recurrent bile duct cancer is generally impractical due to local invasion of surrounding major vascular structures or distant metastases. We describe a case of a relapsed tumor in the right hepatic duct 3 years after pancreatoduodenectomy for middle to distal bile duct cancer. The recurrent tumor, measuring 25 x 12 x 12 mm, was mostly confined within the right hepatic duct. It displayed an intraductal superficial extension rather than transmural invasive growth to the hepatic hilum. An extended right hemihepatectomy was successfully performed with a histologically negative margin. The patient is currently doing well without any signs of local recurrence or distant metastasis 8 months after the second operation. Precise pathological examination revealed that the lesion had originated from multicentric foci in the right hepatic duct, not as a result of anastomotic recurrence. These results raised the consideration of a potentially more indolent subgroup of bile duct cancer. This is a detailed report of a successfully resected recurrent bile duct cancer, for which the patient underwent major hepatectomy as a salvage procedure after pancreatoduodenectomy for the primary tumor. An aggressive surgical approach will be a rational treatment of choice for recurrent disease when metachronous multicentric tumor development in the bile duct is suspected and curative resection can be safely performed.

Key Words: bile duct cancer • recurrence • salvage therapy • hepatectomy


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