Postsegmentectomy for a Local Recurrence of Hilar Cholangiocarcinoma after Central Bisegmentectomy and Caudal Lobectomy

Abstract

Introduction: Surgical resection is the only curative treatment for hilar cholangiocarcinoma but the possibility of local recurrence is high. The standard treatment for recurrent hilar cholangiocarcinoma after operation is chemotherapy and repeated resection is rarely performed. We herein report a rare case that re-hepatectomy was done for a local recurrence of hilar cholangiocarcinoma after central bisegmentectomy and caudal lobectomy. Methods: A report of a case. Results: A 75-year-old woman developed hilar cholangiocarcinoma and underwent extrahepatic bile duct resection with concomitant central bisegmentectomy and caudal lobectomy. The histopathological examination confirmed that R-0 resection had been achieved. After 18 months of the operation, computed tomography(CT) showed a local recurrence of the tumor in the posterior segmental branch of the intrahepatic bile duct with the portal vein invasion. The recurrent tumor was localized only in the region and we decided to operate again. The tumor was resected with the posterior segment, the portal vein and the hepaticojejunosotomy. The patient had an uncomplicated postoperative recovery and was discharged home. Conclusion: We successfully performed re-hepatectomy for a local recurrence of hilar cholangiocarcinoma. As far as we know, such a case has not been reported. In the first operation, we chose not extended right hepatectomy nor extended left hepatectomy but central bisegmentectomy and as a result, remnant liver volume was spared. As a result, she could undergo curative major hepatectomy again.