title: [Two cases of lower bile duct recurrence resected by pancreatoduodenectomy after hepatectomy for hilar cholangiocarcinoma].
abstract: We report 2 rare cases of lower bile duct recurrence resected by pancreatoduodenectomy after hepatectomy for hilar cholangiocarcinoma. Case 1: A 74-year-old man underwent extended right hepatectomy for hilar cholangiocarcinoma (JSBS classification: pT1N0M0, fStage I, fCur A, negative cut end). The serum carbohydrate antigen 19-9 level was elevated 18 months after hepatectomy, but abdominal computed tomography showed no signs of recurrence. However, lower bile duct recurrence was revealed by subsequent magnetic resonance imaging, positron-emission tomography, and endoscopic retrograde cholangiopancreatography. Twenty months after hepatectomy, pancreatoduodenectomy was performed, and the pathological findings showed lower bile duct carcinoma(JSBS classification: pT3N0M0, fStage III, fCur A). The patient survived without recurrence 12 months after a secondary operation. Case 2: A 68-year-old woman underwent extended right hepatectomy for hilar cholangiocarcinoma(JSBS classification: pT3N2M0, fStage IVa, fCur B, negative cut end). Twelve months after hepatectomy, dilatation of the remaining lower bile duct was observed by abdominal computed tomography. Endoscopic retrograde cholangiopancreatography revealed lower bile duct stenosis with suspected malignancy, and positron-emission tomography scan detected increased fluorodeoxyglucose uptake at the stenosis. Fourteen months after the hepatectomy, pancreatoduodenectomy was performed and the pathological findings showed lower bile duct carcinoma(JSBS classification: pT4N2M0, fStage IVb, fCur B). The patient died of local recurrence 6 months after the secondary operation.
authors.affiliation: Dept. of Surgery, Kansai Rosai Hospital, Japan.
authors.forename: Shin
authors.initials: S
authors.lastname: Nakahira
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Takeda
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawashima
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Mukai
authors.forename: Michiko
authors.initials: M
authors.lastname: Hamanaka
authors.forename: Chieko
authors.initials: C
authors.lastname: Uchiyama
authors.forename: Takashi
authors.initials: T
authors.lastname: Kanemura
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Okishiro
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takeno
authors.forename: Rei
authors.initials: R
authors.lastname: Suzuki
authors.forename: Ken
authors.initials: K
authors.lastname: Nakata
authors.forename: Chiyomi
authors.initials: C
authors.lastname: Egawa
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Miki
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kato
authors.forename: Shinichi
authors.initials: S
authors.lastname: Nakatsuka
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Tamura
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000473:pathology / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000473:pathology / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D016577:Pancreaticoduodenectomy; D012008:Recurrence; D016896:Treatment Outcome