A long-term survivor of hilar cholangiocarcinoma with resection of recurrent peritoneal dissemination after R0 surgery: a case report

Tatsunori Miyata,Shigeki Nakagawa,Kota Arima,Hirohisa Okabe,Masayo Tsukamoto,Daisuke Hashimoto,Yuki Kitano,Yo-Ichi Yamashita,Akira Chikamoto,Naoki Umezaki,Hideo Baba,Takanobu Yamao,Katsunori Imai

doi:10.1186/s40792-017-0386-z

Abstract

BackgroundAlthough hilar cholangiocarcinoma (HCCA) has a very poor prognosis, there are cases in which long-term survival is rarely obtained by multidisciplinary treatment.Case presentationA 61-year-old man diagnosed with HCCA was referred to our hospital. We performed an extended left hemi-hepatectomy and caudate lobectomy with extrahepatic bile duct resection. The tumor stage was T2aN0M0, stage II, based on the TNM classification, seventh edition. R0 resection was successfully performed. Adjuvant chemotherapy was not administered. After 38 months, computed tomography revealed peritoneal dissemination. The patient received chemotherapy with tegafur-gimeracil-oteracil-potassium (S-1) and gemcitabine. The peritoneal dissemination was successfully controlled for more than 50 months. During the treatment, levels of CEA and CA19-9 kept rising slowly, which was followed by bowel obstruction due to peritoneal dissemination of HCCA. The patient underwent resection of transverse colon with tumor nodules, and the tumor was pathologically diagnosed as metastasis of HCCA. Tumor markers decreased to normal levels, and the patient has been free from tumor relapse for 6 months.ConclusionsWe here report a rare case of HCCA patient with recurrent peritoneal dissemination 3 years after R0 surgery which was sensitive to chemotherapy. The patient successfully received resection of peritoneal dissemination 50 months after the induction of chemotherapy and survived for 10 years.

Highlights

Hilar cholangiocarcinoma (HCCA) has a very poor prognosis, there are cases in which longterm survival is rarely obtained by multidisciplinary treatment.Case presentation: A 61-year-old man diagnosed with hilar cholangiocarcinoma (HCCA) was referred to our hospital
We here report a rare case of HCCA patient with recurrent peritoneal dissemination 3 years after R0 surgery which was sensitive to chemotherapy
We found that a risk-signature including CD8+ T cell status predict prognosis and sensitivity to chemotherapy after curative resection in extrahepatic cholangiocarcinoma [24]

Summary

Conclusions

We here report a rare case of HCCA patient with recurrent peritoneal dissemination which occurred 38 months after curative surgery and successfully resected 50 months after the induction of chemotherapy. The patient survived more than 10 years after initial resection maintaining normal tumor marker level. Availability of data and materials This study was not funded. Authors’ contributions TM described and designed the article. HB and AC supervised the edition of the manuscript. Other remaining co-authors collected the data and discussed the content of the manuscript. All authors read and approved the final manuscript. Ethics approval and consent to participate Written informed consent was obtained from the patient for publication of this case report and any accompanying images. Competing interests The authors declare that they have no conflict of interest. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations

Background

Discussion