A resected case of hepato-pancreaticoduodenectomy for widely extended cholangiocarcinoma undergoing previous intra-abdominal poly-surgery. (2018)

• Record Type: Journal Article
• Authors: Nanashima, Atsushi; Imamura, Naoya; Hiyoshi, Masahide; Yano, Koichi; Hamada, Takeomi; Chiyotanda, Teru; Nagatomo, Kenzo; Hamada, Rouko; Ito, Hiroshi
• Is Part Of: International journal of surgery case reports. Volume 53(2018)
• Page Start: 85
• Page End: 89
• Publication Date: 2018
• Subjects: Hepato-pancreaticoduodenectomy -- Previous poly-surgery -- Careful managements; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2018.10.035
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Patients undergoing poly surgery have been increased due to improvement of postoperative managements. We experienced a patient with widely spreading cholangiocarcinoma who had previously undergone polysurgery. Even though the complicated prior surgery in the abdomen, the R0 operation can be safely completed by expert surgeons. Abstract: Introduction: This case report describes a successful radical operation for a patient with extensive advanced cholangiocarcinoma who had previously undergone intra-abdominal poly-surgery for advanced gall bladder carcinoma. Careful diagnosis to define the adequate division of the right hepatic duct was performed, and the operation was completed without postoperative complications. Case presentation: A 61-year-old woman was admitted to a hospital for obstructive jaundice, and extra-hepatic cholangiocarcinoma was found. Seven years prior, she underwent poly-surgery, which included cholecystectomy, gastrectomy, and colectomy, for advanced gall bladder carcinoma. Although she did not receive adjuvant chemotherapy, she had no tumor relapse. She was recommended chemo-radiation therapy to treat the cholangiocarcinoma; however, she visited our hospital to inquire the possibility of receiving radical operation. Enhanced computed tomography showed extensive cholangiocarcinoma without distant metastases, which was confirmed by endoscopic biopsy. Since the transected bile duct was without cancer-invasion, which was confirmed by a negative biopsy result, we were able to perform radical left hepatectomy and pancreaticoduodenectomy (HPD). The patient was discharged without any complications. Careful preoperative examination allowed for a complex operation to be successfully completed. Discussion: Complex surgery for advanced hepato-biliary-pancreatic malignancies after poly-surgery is difficult and requires expertise and intensive postoperative care. Conclusion: HPB surgeons should adopt an aggressive policy to treat patients who have undergone previous major abdominal surgery.