title: Long-term survival of intrahepatic cholangiocarcinoma with hilar lymph node metastasis and portal vein involvement.
abstract: We report the case of a very rare 6-year disease-free survivor of intrahepatic cholangiocarcinoma with hilar lymph node metastasis and portal vein involvement. A 76-year-old female with liver dysfunction was referred to our institution. Contrast-enhanced computed tomography showed a 5-cm low-density tumor with irregular marginal enhancement in the left and caudate lobes of the liver. Cholangiography revealed complete obstruction of the left hepatic bile duct. Angiography showed obstruction of the left branch of the portal vein. Metastasis to the hilar lymph nodes was disclosed at surgery. The patient underwent left hepatectomy with caudate lobectomy, resection of the extrahepatic bile duct, and lymphadenectomy. The total vascular exclusion of the liver was used for hepatectomy and reconstruction of the portal vein. Microscopically, the tumor was a poorly differentiated adenocarcinoma with many infiltrating lymphocytes, and extensive necrosis was present within the tumor. The experience gained in the present case suggests that aggressive surgery may be a potential approach to provide a hope of long-term survival for patients with intrahepatic cholangiocarcinoma despite the presence of regional lymph node metastasis and vascular invasion.
authors.affiliation: Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Tomotaka
authors.initials: T
authors.lastname: Akatsu
authors.forename: Motohide
authors.initials: M
authors.lastname: Shimazu
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Kawachi
authors.forename: Minoru
authors.initials: M
authors.lastname: Tanabe
authors.forename: Koichi
authors.initials: K
authors.lastname: Aiura
authors.forename: Go
authors.initials: G
authors.lastname: Wakabashi
authors.forename: Masakazu
authors.initials: M
authors.lastname: Ueda
authors.forename: Michiie
authors.initials: M
authors.lastname: Sakamoto
authors.forename: Masaki
authors.initials: M
authors.lastname: Kitajima
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000601:surgery; D018281:Cholangiocarcinoma / Q000473:pathology / Q000601:surgery*; D002758:Cholangiography; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D009361:Neoplasm Invasiveness / Q000000981:diagnostic imaging*; D011169:Portal Vein / Q000000981:diagnostic imaging* / Q000601:surgery; D019651:Plastic Surgery Procedures; D016019:Survival Analysis