Radiological findings and surgical outcomes of pulmonary metastases originating from biliary tract carcinoma

  • Koji KawaguchiEmail author
  • Tetsuo Taniguchi
  • Takayuki Fukui
  • Shota Nakamura
  • Kohei Yokoi
Original Article



Metastasis to the lungs arising from biliary tract carcinoma (BTC) is extremely rare, and the patient characteristics and prognosis are not well known. We aimed to identify the imaging findings of pulmonary metastases originating from BTC and the eligible indications for surgical treatment.


Fifteen patients who underwent pulmonary resection for metastases originating from BTC were retrospectively analyzed.


The primary sites included cholangiocarcinoma (n = 12) and gallbladder carcinoma (n = 3), and all cases were histologically diagnosed as well to moderately differentiated adenocarcinomas. The median disease-free interval between resection for the primary site and the detection of pulmonary metastasis was 30 months (range 0–144 months). Nine patients had a single lesion, and six had multiple lesions. As features of pulmonary lesions on thin-section computed tomography (CT), many appeared as solid nodules with smooth margins, whereas six lesions were concomitant with spiculation or pleural indentation, three with air bronchogram or ground-glass attenuation, and one with intra-tumoral cavity, and six cases with solitary pulmonary lesion were diagnosed as primary lung cancer before metastasectomy. The 3-year survival rate in the 11 patients who underwent complete metastasectomy was 45%. A disease-free interval of more than 3 years (p = 0.03) and single lesion (p < 0.01) were significant prognostic factors.


The CT findings of pulmonary metastases from BTCs sometimes resemble the characteristic findings of primary lung cancer. A long disease-free interval and single lesion are therefore considered to be good surgical indicators.


Biliary tract carcinoma Computed tomography Pulmonary metastases Metastasectomy Radiological findings 


Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest in association with this study.


  1. 1.
    Nagino M, Ebata T, Yokoyama Y, Igami T, Sugawara G, Takahashi Y, et al. Evolution of surgical treatment for perihilar cholangiocarcinoma: a single-center 34-year review of 574 consecutive resections. Ann Surg. 2013;258:129–40.CrossRefGoogle Scholar
  2. 2.
    DeOliveira ML, Cunningham SC, Cameron JL, Kamangar F, Winter JM, Lillemoe KD, et al. Cholangiocarcinoma: thirty-one-year experience with 564 patients at a single institution. Ann Surg. 2007;245:755–62.CrossRefGoogle Scholar
  3. 3.
    Shimada M, Yamashita Y, Aishima S, Shirabe K, Takenaka K, Sugimachi K. Value of lymph node dissection during resection of intrahepatic cholangiocarcinoma. Br J Surg. 2001;88:1463–6.CrossRefGoogle Scholar
  4. 4.
    Saiura A, Yamamoto J, Kokudo N, Koga R, Seki M, Hiki N, et al. Intrahepatic cholangiocarcinoma: analysis of 44 consecutive resected cases including 5 cases with repeat resections. Am J Surg. 2011;201:203–8.CrossRefGoogle Scholar
  5. 5.
    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. 2012;256:297–305.CrossRefGoogle Scholar
  6. 6.
    Weber SM, Jarnagin WR, Klimstra D, et al. Intrahepatic cholangiocarcinoma: resectability, recurrence pattern, and outcomes. J Am Coll Surg. 2001;193:384–91.CrossRefGoogle Scholar
  7. 7.
    Takahashi Y, Ebata T, Yokoyama Y, Igami T, Sugawara G, Mizuno T, et al. Surgery for recurrent biliary tract cancer: a single-center experience with 74 consecutive resections. Ann Surg. 2015;262:121–9.CrossRefGoogle Scholar
  8. 8.
    Robinson LA, Tanvetyanon T, Springett G, Fontaine J, Toloza E, Hodul P, et al. Pulmonary metastasectomy for suspected pancreaticobiliary cancer. J Thorac Cardiovasc Surg. 2016;152:75–82.CrossRefGoogle Scholar
  9. 9.
    Yamada M, Ebata T, Yokoyama Y, Igami T, Sugawara G, Mizuno T, et al. Pulmonary metastasis after resection of cholangiocarcinoma: incidence, resectability, and survival. World J Surg. 2017;41:1550–7.CrossRefGoogle Scholar
  10. 10.
    Miyazaki M, Ohtsuka M, Miyakawa S, Nagino M, Yamamoto M, Kokudo N et al (2015) Classification of biliary tract cancers established by the Japanese Society of Hepato-Biliary-Pancreatic Surgery: 3rd English edition. J Hepatobiliary Pancreat Sci 22:181–196Google Scholar
  11. 11.
    Miyazaki M, Yoshitomi H, Miyakawa S, Uesaka K, Unno M, Endo I et al (2015) Clinical practice guidelines for the management of biliary tract cancers 2015: the 2nd English edition. J Hepatobiliary Pancreat Sci 22:249–273Google Scholar
  12. 12.
    Saxena A, ChuaTC, Chu FC, Morris DL (2011) Improved outcomes after aggressive surgical resection of hilar cholangiocarcinoma: a critical analysis of recurrence and survival. Am J Surg 202:310–320.Google Scholar
  13. 13.
    Girard P, Baldeyrou P, Le Chevalier T, Lemoine G, Tremblay C, Spielmann M, et al. Surgical resection of pulmonary metastases: up to what number? Am J Respir Crit Care Med. 1994;149:469–76.CrossRefGoogle Scholar
  14. 14.
    Rena O, Davoli F, Boldorini R, Roncon A, Baietto G, Papalia E, et al. The solitary pulmonary nodule in patients with previous cancer history: results of surgical treatment. Eur J Surg Oncol. 2013;39:1248–53.CrossRefGoogle Scholar
  15. 15.
    Primack SL, Lee KS, Logan PM, Miller RR, Müller NL. Bronchogenic carcinoma: utility of CT in the evaluation of patients with suspected lesions. Radiology. 1994;193:795–800.CrossRefGoogle Scholar
  16. 16.
    Siegelman SS, Khouri NF, Leo FP, Fishman EK, Braverman RM, Zerhouni EA. Solitary pulmonary nodules: CT assesment. Radiology. 1986;160:307–12.CrossRefGoogle Scholar
  17. 17.
    Way TW, Sahiner B, Chan HP, Hadjiiski L, Cascade PN, Chughtai A, et al. Computer-aided diagnosis of pulmonary nodules on CT scans: improvement of classification performance with nodule surface features. Med Phys. 2009;36:3086–98.CrossRefGoogle Scholar
  18. 18.
    Park SY, Kim BH, Kim JH, Lee S, Kang GH. Panels of immunohistochemical markers help determine primary sites of metastatic adenocarcinoma. Arch Pathol Lab Med. 2007;131:1561–7.Google Scholar
  19. 19.
    Javle M, Lowery M, Shroff RT, Weiss KH, Springfeld C, Borad MJ, et al. Phase II study of BGJ398 in patients With FGFR-altered advanced cholangiocarcinoma. J Clin Oncol. 2018;36:276–82.CrossRefGoogle Scholar

Copyright information

© The Japanese Association for Thoracic Surgery 2019

Authors and Affiliations

  1. 1.Department of Thoracic SurgeryNagoya University Graduate School of MedicineNagoyaJapan
  2. 2.Division of Thoracic SurgeryKomaki City HospitalKomakiJapan

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