title: Hepatopancreatoduodenectomy for anastomotic recurrence from residual cholangiocarcinoma: report of a case.
abstract: Resection of cholangiocarcinoma often results in a positive ductal margin, from carcinoma in situ (CIS) near the main tumor; however, the biological behavior of the residual CIS after surgical resection remains equivocal. We report a case of late local recurrence of CIS, defined as long-term tumor progression from CIS residue at the ductal stump. The patient, a 73-year-old man, had undergone bile duct resection for distal cholangiocarcinoma, leaving positive ductal margins with CIS. A biliary stricture was found 10 years later at the site of anastomosis, and right hepatectomy with pancreatoduodenectomy was performed. Based on histological analogy and the evidence of remnant CIS, a final diagnosis of late local recurrence from the CIS foci was made. This uncommon mode of recurrence should be considered in patients with early-stage disease with expected favorable survival because salvage surgery is feasible for selected patients.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan, seijinn@hotmail.com.
authors.forename: Seiji
authors.initials: S
authors.lastname: Natsume
authors.forename: Tomoki
authors.initials: T
authors.lastname: Ebata
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Yokoyama
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Igami
authors.forename: Gen
authors.initials: G
authors.lastname: Sugawara
authors.forename: Yu
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Masato
authors.initials: M
authors.lastname: Nagino
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D001650:Bile Duct Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D001652:Bile Ducts / Q000601:surgery; D002278:Carcinoma in Situ / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000601:surgery*; D003952:Diagnostic Imaging; D018450:Disease Progression; D006498:Hepatectomy; D006801:Humans; D008297:Male; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000601:surgery*; D009378:Neoplasms, Multiple Primary; D016577:Pancreaticoduodenectomy; D016879:Salvage Therapy; D013997:Time Factors