Multimodal Treatment for Hepatic Recurrence after Surgical Resection of Hilar Cholangiocarcinoma: A Case Report

Abstract

Introduction: The surgical resection is a definite treatment for hilar cholangiocarcinoma. However, the optimal treatment for the recurrence after initial surgical treatment has not been established. We report a case of multimodal treatment using chemotherapy and surgical re-resection for the recurrence after extended right hepatectomy and bile duct resection for hilar cholangiocarcinoma. Method: A 67-year-old man underwent right hepatectomy and caudate lobectomy, hilar bile duct resection, and portal vein segmental resection for hilar cholangiocarcinoma (pT2bN0, pStage II) in March 2014. After that, he received adjuvant concurrent chemoradiotherapy (CCRT) with 5-fluorouracil plus leucovorin. After 2 cycles of adjuvant CCRT, he was treated only with adjuvant chemotherapy for 5 cycles. However, S4 segment recurrence involved with inferior vena cava was detected on Computer Tomography (CT) and Positron-Emission Tomography (PET) at 37 months after the initial surgery. Result: The liver biopsy revealed cholangiocarcinoma recurrence in April 2017. After 6 cycles of palliative chemotherapy consisting of gemcitabine plus cisplatin, follow-up CT and PET-CT showed a partial response of S4 recurrent tumor. The reoperation was decided because the recurrence did not show any other metastases and the patient was stable during the 5-month palliative chemotherapy. He underwent S4 segmentectomy and hepaticojejunostomy revision with jejunum segmental resection for recurrent cholangiocarcinoma in September 2017. Subsequently, He received the same chemotherapy consisting of gemcitabine plus cisplatin after the second surgery. To date, he has been alive for 60 months since the initial resection of primary lesion and for 18 months since the second resection of recurrent tumor. Conclusion: This case shows that multimodal treatment such as surgery with chemotherapy could improve the prognosis for the highly selected recurrent hilar cholangiocarcinoma.