Is Pancreaticoduodenectomy Feasible for Recurrent Remnant Bile Duct Cancer Following Bile Duct Segmental Resection?
BACKGROUND
When bile duct cancer recurs after surgery, treatment options are limited. This study examines the usefulness of reoperative pancreaticoduodenectomy for recurrent cancer after initial segmental bile duct resection.


METHODS
Six patients (5 males, 1 females; median age 65 years) who underwent pancreaticoduodenectomy for recurrent remnant bile duct cancer following segmental bile duct resection were included: 4 underwent surgery at Severance Hospital and 2 at Gangnam Severance Hospital from January 2000 to December 2013. Medical records data were retrospectively reviewed, including demographics, type of first and second surgery, radicality of resection, TNM stage, adjuvant treatments, complications, and survival. Kaplan-Meier curves were used to analyze survival.


RESULTS
The median interval between operations was 57 (range 7-95) months. Median operation time was 6.9 (range 5.2-12.8) h, blood loss was 400 (range 50-1170) mL, intensive care unit stay was 1 (range 1-2) day, and postoperative hospital stay was 33 (range 15-55) days. No patient died. Four had severe complications. The median survival after pancreaticoduodenectomy was 16 (range 5-89) months. Four patients had recurrence. T stage, N stage, and resection radicality influenced survival.


CONCLUSIONS
Pancreaticoduodenectomy is reasonable for recurrent remnant bile duct cancer following segmental bile duct resection, particularly for patients with no distant metastasis, locally confined recurrence, and good general condition.
Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea. drjg1@yuhs.ac.
Jae Geun
JG
Lee
Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea. leeshmd77@yuhs.ac.
Sung Hwan
SH
Lee
Department of Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea. doctorjin77@naver.com.
Jin Hong
JH
Lim
Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea. jspark330@yuhs.ac.
Joon Seong
JS
Park
Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea. yds6110@yuhs.ac.
Dong Sup
DS
Yoon
Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea. kskim88@yuhs.ac.|Department of Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea. kskim88@yuhs.ac.
Kyung Sik
KS
Kim
D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001652:Bile Ducts / Q000473:pathology; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D061646:Operative Time; D016577:Pancreaticoduodenectomy; D012189:Retrospective Studies; D016896:Treatment Outcome
Pancreaticoduodenectomy; Recurrent remnant bile duct cancer; Reoperation; Segmental bile duct resection