Major hepatectomy combined with pylorus-preserving pancreatoduodenectomy for middle bile duct cancer with multiple lymph node metastases: a case report of 5-year survival
Kurosaki, I.; Hatakeyama, K.; Tsukada, K.; Date, K.; Tomiyama, T.
Hepato-Gastroenterology 46(27): 1623-1626
1999
ISSN/ISBN: 0172-6390 PMID: 10430307 Document Number: 507953
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.