Long-term survival for 11.5 years after percutaneous transhepatic cholangioscopic microwave tissue coagulation (MTC) in a jaundiced man with bile duct carcinoma and Schnitzler's metastasis due to colon carcinoma

Abstract

We previously reported an inoperable jaundiced woman and man with bile duct carcinoma who underwent cholangioscopic MTC and survived longer than 13 and 15 years, respectively. Here, we report another jaundiced patient with bile duct carcinoma with survival longer than 10 years after cholangioscopic and X-ray image-guided MTC.A 56-year-old man was referred to our institution because of right hypochondric pain and constipation with suspected postoperative intestinal stenosis. Three years previously, he had undergone a non-curative resection of carcinoma in the transverse colon, in which both the second group of regional lymph nodes and pelvic tumor were histologically metastatic (Schnitzler's metastasis).Besides abdominal pain, he had bulbar jaundice, increased serum bilirubin and amylase, and leucocytosis. Percutaneous transhepatic cholangial drainage (PTCD) was performed for biliary decompression with improvement of jaundice, followed by fluorographically complete obstruction of the common bile duct (CBD) suggestive of a neoplastic lesion. Percutaneous transhepatic cholangioscopy (PTCS) revealed a papillary tumor in the terminal portion of the CBD, with a histological diagnosis of papillary adenocarcinoma.Given his previous non-curative resection of colon cancer, he did not wish to undergo pancreatoduodenectomy (PD) as radical surgery. Therefore, cholangioscopic and X-ray image-guided MTC using Microtaze® (Heiwa Electronic Industrial Co. Ltd., Osaka Japan), a 1.8 mm φ spherical antenna, and a 5 mm φ bullet-shaped antenna covering a thin guide wire (0.028 inch, Cook Co. Ltd., USA) was carried out under radiation of 45 watts and repetitions of 3-5 seconds in duration.The patient lived for 11.5 years after the onset of pain and jaundice.For malignant neoplasms in the early stage of progression in the bile duct, cholangioscopic methods including MTC may be a treatment option aimed at cure, as are bronchoscopic methods for lung cancer in the early stage of progression.