P3-30-3 - Combination of Repeated Surgery and Perioperative Chemotherapy for Metachronous Double Bile Duct Cancer

Abstract

A 69-year-old woman was admitted due to jaundice. Enhanced CT scan showed advanced gallbladder cancer invading the liver parenchyma. After three courses of gemcitabine (GEM) therapy were administered as neoadjuvant chemotherapy, extended right hemihepatectomy was performed. Postoperative adjuvant chemotherapy was canceled due to the patient's refusal. Nine months after the surgery, CA19-9 level was increased and follow-up CT detected hilar lymph node swelling, which strongly suggested recurrence of the disease. Chemotherapy using S-1 was introduced but was stopped because of progressive disease response. Instead, GEM therapy was administered and a partial response was observed which persisted for about five years thereafter. However, 76 months after the operation, jaundice was noted and solitary hilar mass lesion was detected by a follow-up CT and FDG-PET, without any other distant metastasis. The patient underwent extrahepatic bile duct resection with partial resection of the portal vein due to direct tumor invasion, and pathologically the tumor was diagnosed hilar cholangiocarcinoma. Since cancer infiltration of the intrahepatic bile duct stump was histologically positive, combination chemotherapy using GEM plus CDDP was administered. The patient is currently 76 years of age, 7 years after the initial surgery, and she is still doing well without any signs of recurrence. Metachronous multiple carcinomas of the biliary system are relatively uncommon due to the rarity of cholangiocarcinoma and its poor prognosis. Although some selected patients with bile duct cancer have a chance of long-term survival thanks to recent advances in both surgical resection and combination chemotherapy, standardization of chemotherapy or other therapeutic modalities has not been established for the treatment of such critical patients. We discussed feasibility and safety of multidsciplinary treatment for metachronous multiple bile duct cancers with the review of the literature.