Surgery Today

, Volume 44, Issue 5, pp 952–956 | Cite as

Hepatopancreatoduodenectomy for anastomotic recurrence from residual cholangiocarcinoma: report of a case

  • Seiji Natsume
  • Tomoki Ebata
  • Yukihiro Yokoyama
  • Tsuyoshi Igami
  • Gen Sugawara
  • Yu Takahashi
  • Masato Nagino
Case Report


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.


Anastomotic recurrence Cholangiocarcinoma Carcinoma in situ 


  1. 1.
    Ebata T, Nagino M, Nishio H, Arai T, Nimura Y. Pathological appraisal of lines of resection for bile duct carcinoma. Br J Surg. 2002;89:1260–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Igami T, Nagino M, Oda K, Nishio H, Ebata T, Yokoyama Y, et al. Clinicopathologic study of cholangiocarcinoma with superficial spread. Ann Surg. 2009;249:296–302.PubMedCrossRefGoogle Scholar
  3. 3.
    Nakanuma Y, Harada K, Ishikawa A, Zen Y, Sasaki M. Anatomic and molecular pathology of intrahepatic cholangiocarcinoma. J Hepatobilliary Pancreat Surg. 2003;10:265–81.CrossRefGoogle Scholar
  4. 4.
    Nakanishi Y, Kondo S, Zen Y, Yonemori A, Kubota K, Kawakami H, et al. Impact of residual in situ carcinoma on postoperative survival in 125 patients with extrahepatic bile duct carcinoma. J Hepatobiliary Pancreat Sci. 2010;17:166–73.PubMedCrossRefGoogle Scholar
  5. 5.
    Wakai T, Shirai Y, Moroda T, Yokoyama N, Hatakeyama K. Impact of ductal resection margin status on long-term survival in patients undergoing resection for extrahepatic cholangiocarcinoma. Cancer. 2005;103:1210–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Hibi T, Sakamoto Y, Tochigi N, Ojima H, Shimada K, Sano T, et al. Extended right hemihepatectomy as a salvage operation for recurrent bile duct cancer 3 years after pancreatoduodenectomy. Jpn J Clin Oncol. 2006;36:176–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Nakanishi Y, Kondo S, Hirano S, Ambo Y, Tanaka E, Morikawa T, et al. Recurrence of mucosal carcinoma of the bile duct, with superficial flat spread, 12 years after operation. J Hepatobiliary Pancreat Surg. 2006;13:355–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Sasaki T, Kondo S, Ambo Y, Hirano S, Sichinohe T, Kaga K, et al. Local recurrence at hepaticojejunostomy 9 years after resection of bile duct cancer with superficial flat spread. J Hepatobiliary Pancreat Surg. 2006;13:458–62.PubMedCrossRefGoogle Scholar
  9. 9.
    Tanaka N, Nobori M. KohzumaT, Suzuki Y, Saiki S. Anastomotic recurrence at hepaticojejunostomy in a long-term survivor of bile duct carcinoma: report of a case. Surg Today. 1994;24:280–4.PubMedCrossRefGoogle Scholar
  10. 10.
    Bassi C, Dervenis C, Butturini G, Finqerhut A, Yeo C, Izbicki J, et al. Post operative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138:8–13.PubMedCrossRefGoogle Scholar
  11. 11.
    International Union Against Cancer (UICC). TNM classification of malignant tumors. 7th ed. New York: Wiley; 2009.Google Scholar
  12. 12.
    Kobayashi A, Miwa S, Nakata T, Miyagawa S. Disease recurrence patterns after R0 resection of hilar cholangiocarcinoma. Br J Surg. 2010;97:56–64.PubMedCrossRefGoogle Scholar
  13. 13.
    Konishi M, Iwasaki M, Ochiai A, Hasebe T, Ojima H, Yanagisawa A. Clinical impact of intraoperative histological examination of the ductal resection margin in extrahepatic cholangiocarcinoma. Br J Surg. 2010;97:1363–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Endo I, House MG, Klimstra DS, Gönen M, D’Angelica M, Dematteo RP, et al. Clinical significance of intraoperative bile duct margin assessment for hilar cholangiocarcinoma. Ann Surg Oncol. 2008;15:2104–12.PubMedCrossRefGoogle Scholar
  15. 15.
    Sasaki R, Takeda Y, Funato O, Nitta H, Kawamura H, Uesugi N, et al. Significance of ductal margin status in patients undergoing surgical resection for extrahepatic cholangiocarcinoma. World J Surg. 2007;31:1788–96.PubMedCrossRefGoogle Scholar
  16. 16.
    Tocchi A, Mazzoni G, Liotta G, Lepre L, Cassini D, Miccini M. Late development of bile duct cancer in patients who had biliary-enteric drainage for benign disease: a follow-up study of more than 1,000 patients. Ann Surg. 2001;234:210–4.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Suzuki M, Takahashi T, Ouchi K, Matsuno S. The development and extension of hepatohilar bile duct carcinoma. A three-dimensional tumor mapping in the intrahepatic biliary tree visualized with the aid of a graphics computer system. Cancer. 1989;64:658–66.PubMedCrossRefGoogle Scholar
  18. 18.
    Takahashi Y, Nagino M, Nishio H, Ebata T, Igami T, Nimura Y. Percutaneous transhepatic biliary drainage catheter tract recurrence in cholangiocarcinoma. Br J Surg. 2010;97:1860–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Yoon YS, Kim SW, Jang JY, Park YH. Curative reoperation for recurrent cancer of the extrahepatic bile duct: report of two cases. Hepatogastroenterology. 2005;52:381–4.PubMedGoogle Scholar
  20. 20.
    Seki H, Miyagawa S, Kobayashi A, Kawasaki S. Surgical treatment for biliary carcinoma arising after pancreatoduodenectomy. HPB Surg. 1998;10:395–7.PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Targarona EM, Zografos G, Habib NA. Liver resection for recurrent hilar cholangiocarcinoma. Br J Surg. 1993;80:1433.PubMedCrossRefGoogle Scholar
  22. 22.
    Ebata T, Yokoyama Y, Igami T, Sugawara G, Takahashi Y, Nimura Y, et al. Hepatopancreatoduodenectomy for cholangiocarcinoma: A single-center review of 85 consecutive patients. Ann Surg (in press).Google Scholar

Copyright information

© Springer Japan 2013

Authors and Affiliations

  • Seiji Natsume
    • 1
  • Tomoki Ebata
    • 1
  • Yukihiro Yokoyama
    • 1
  • Tsuyoshi Igami
    • 1
  • Gen Sugawara
    • 1
  • Yu Takahashi
    • 1
  • Masato Nagino
    • 1
  1. 1.Division of Surgical Oncology, Department of SurgeryNagoya University Graduate School of MedicineNagoyaJapan

Personalised recommendations