title: Major hepatectomy combined with pylorus-preserving pancreatoduodenectomy for middle bile duct cancer with multiple lymph node metastases: a case report of 5-year survival.
abstract: Hepatopancreatoduodenectomy has been well established as an aggressive surgical approach for advanced biliary tract malignancy. However, long-term survival of more than 5 years after this operation is rarely reported, especially with bile duct carcinoma. We report herein a 64 year-old man with middle bile duct cancer who underwent extended right hepatectomy combined with pylorus-preserving pancreatoduodenectomy because of widespread intramural extension of the tumor. Resection margin, which is considered the most significant prognostic parameter, was made clear only by additional hepatectomy in this case. In addition, although microscopic examination revealed multiple lymph node involvement up to the superior mesenteric node, the patient has survived 5 years and 6 months without tumor recurrence. It remains unclear whether aggressive lymph node dissection may improve surgical outcome; however, it is thought that surgical clearance of potentially involved nodes and tissue may be the only chance for long-term survival.
authors.affiliation: First Department of Surgery, Niigata University School of Medicine, Niigata City, Japan.
authors.forename: I
authors.initials: I
authors.lastname: Kurosaki
authors.forename: K
authors.initials: K
authors.lastname: Hatakeyama
authors.forename: K
authors.initials: K
authors.lastname: Tsukada
authors.forename: K
authors.initials: K
authors.lastname: Date
authors.forename: T
authors.initials: T
authors.lastname: Tomiyama
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002758:Cholangiography; D003135:Common Bile Duct / Q000473:pathology / Q000601:surgery; D003138:Common Bile Duct Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D006498:Hepatectomy; D006500:Hepatic Duct, Common / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008099:Liver / Q000473:pathology; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010179:Pancreas / Q000473:pathology; D016577:Pancreaticoduodenectomy; D015996:Survival Rate