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Japanese Journal of Clinical Oncology Advance Access published online on February 14, 2006
Japanese Journal of Clinical Oncology, doi:10.1093/jjco/hyi232
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© 2006 Foundation for Promotion of Cancer Research
Received October 12, 2005
Accepted November 29, 2005

Case Report

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

Taizo Hibi 1, Yoshihiro Sakamoto 1 *, Naobumi Tochigi 1, Hidenori Ojima 2, Kazuaki Shimada 1, Tsuyoshi Sano 1, and Tomoo Kosuge 1

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

* To whom correspondence should be addressed.
Yoshihiro Sakamoto, E-mail: yosakamo{at}ncc.go.jp


  Abstract

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.

Keywords: bile duct cancer; recurrence; salvage therapy; hepatectomy.
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