J Korean Surg Soc.  2003 Nov;65(5):467-473.

The Results of Curative Reoperation for Recurrent Cancer of the Extrahepatic Biliary Tract

Affiliations
  • 1Department of Surgery, Seoul National University College of Medicine, Seoul, Korea. sunkim@plaza.snu.ac.kr

Abstract

PURPOSE
Local recurrence, following a resection for cancer of the gallbladder (GB) and bile duct, is usually incurable; with 2nd curative surgery being almost impossible. To determine the feasibility and significance of 2nd curative surgery, our experiences are presented in this study. METHODS: The medical records and clinical outcomes of 4 patients that underwent a re-resection for recurrent cancer of the extrahepatic biliary tract were retrospectively reviewed. RESULTS: The mean age of the four patients was 51.5 years. One patient that had a recurrent disease at the intrahepatic and intrapancreatic bile duct, 66 months after a segmental resection of the bile duct for common bile duct (CBD) cancer, underwent a hepatopancreatoduodenectomy. The second patient had a recurrent tumor mass in the CBD originating from in a cystic duct, 11 months after a cholecystectomy, and underwent a segmental resection of the bile duct. The third patient had a recurrent disease in the distal CBD, 28 months after a right hepatectomy for a Klatskin tumor, and underwent a pylorus-preserving pancreatoduodenectomy. The gross type of the above 3 cases was a papillary tumor. The fourth patient had a recurrent tumor mass of the liver parenchyma, close to the previous resection margin, 16 months after a cholecystectomy and wedge resection of the GB bed at another hospital for GB cancer, and underwent a wider wedge resection of the GB bed. There were no operative mortalities or morbidities. All patient are still alive after 46, 63, 9 and 30 months, respectively, without recurrence after the reoperation. CONCLUSION: It is concluded that a surgical re-resection is possible in selected patients with recurrent bile duct cancer, mostly of the papillary type. A primary operation for bile duct cancer should be performed with a wide surgical margin, and secondary curative surgery should be considered whenever possible in cases of recurrence.

Keyword

Extrahepatic bile duct cancer; GB cancer; Recurrence; Re-resection

MeSH Terms

Bile Duct Neoplasms
Bile Ducts
Biliary Tract*
Cholecystectomy
Common Bile Duct
Cystic Duct
Gallbladder Neoplasms
Hepatectomy
Humans
Klatskin's Tumor
Liver
Medical Records
Mortality
Pancreaticoduodenectomy
Recurrence
Reoperation*
Retrospective Studies
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