Ann Hepatobiliary Pancreat Surg.  2018 May;22(2):173-177. 10.14701/ahbps.2018.22.2.173.

A long-term survival case of advanced biliary cancer with repeated resection due to recurrence in the pancreaticogastrostomy site after pancreaticoduodenectomy

• Eto S
• Ishikawa M
• Asanoma M
• Tashiro Y
• Matsuyama
• Oshio T

• KMID: 2412435
• DOI: http://doi.org/10.14701/ahbps.2018.22.2.173

Abstract

A 62-year-old man underwent endoscopic mucosal resection for early gastric cancer. The follow-up computed tomography revealed biliary dilatation. The tumor was located in the lower bile duct with biliary dilatation, and no evidence of metastasis in other organs was noted. The patient underwent subtotal stomach-preserving pancreatoduodenectomy with pancreaticogastrostomy and Billroth I anastomosis. At 13 months after the operation, gastrointestinal endoscopy revealed a tumor lesion in the pancreaticogastrostomy site. Computed tomography revealed that the lesion was low enhanced in the pancreaticogastrostomy site and there was no evidence of other distant metastasis. Partial pancreatectomy was performed. Pathological findings of the tumor in the stump of the pancreas revealed findings similar to that of primary biliary carcinoma. Apparently, the patient was diagnosed with recurrence of bile duct cancer via the pancreatic duct. The patient underwent adjuvant chemotherapy for one year subsequent to partial pancreatectomy as the second operation. For 40 months after the second operation, there has been no evidence of recurrence of cancer.

Keyword

Biliary cancer; Surgery; Recurrence; Pancreaticoduodenectomy; Pancreaticogastrostomy

MeSH Terms

Bile Duct Neoplasms
Bile Ducts
Chemotherapy, Adjuvant
Dilatation
Endoscopy, Gastrointestinal
Follow-Up Studies
Gastroenterostomy
Humans
Middle Aged
Neoplasm Metastasis
Pancreas
Pancreatectomy
Pancreatic Ducts
Pancreaticoduodenectomy*
Recurrence*
Stomach Neoplasms

Figure

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  Fig. 1 Computed tomography findings showing tumor of the lower bile duct with biliary dilatation (arrow).

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  Fig. 2 Magnetic resonance imaging showed that the tumor was low intensity at T1WI, iso-high intensity at T2WI and high intensity at diffusion-weighted image (DWI) (arrows).

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  Fig. 3 Magnetic resonance cholangiopancreatography findings. (A) Biliary dilatation and filling defect of lower bile duct were observed. (B) No abnormality in the pancreatic duct was observed.

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  Fig. 4 Operative finding of the first operation. (A) Surgical findings of the pancreaticogastric anastomosis in the first operation (white arrow). (B) Transgastric pancreaticogastric anastomosis was performed. The pancreaticogastric anastomosis was made using full-thickness sutures of the stomach to the pancreas. Subsequently, gastrojejunectomy was performed using Billroth I method.

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  Fig. 5 Gastrointestinal endoscopy finding after 13 months of first operation: the recurrence at pancreaticogastrostomy site was noted.

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  Fig. 6 Positron emission tomography computed tomography showing hypermetabolic uptake indicating recurrence (arrow).

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  Fig. 7 Surgical findings of the second operation.

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  Fig. 8 Comparison of the pathological findings. (A) Pathological finding from the first operation. (B) Pathological finding of the recurrent lesion. Both the lesions revealed similar findings.

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