SYNCHRONOUS DOUBLE CANCER OF THE EXTRAHEPATIC BILE DUCT AND LUNG -REPORT OF A RESECTED CASE ON A TWO-STEP APPROACH-

Abstract

Recently double cancer has been increasingly reported with an increase in the aged population, an advance of diagnostic instruments and a technical improvement of cancer therapy.It is exceedingly rare that synchrous double cancer of the bile duct and lung has been successfully resected. This paper describes a resected case of synchronous cancer of extrahepatic bile duct (adenocarcinoma) and lung (squamous cell carcinoma).A 68-year-old man was admitted to the hospital for close examination because of bloody phlegm, a tumorous lesion on a X-ray film, and jaundice. By TBLB, a tumor of the left lower lobe was diangosed as squamous cell carcinoma. By PTCS biopsy, a stenosis of the distal bile duct was diagnosed as moderately differentiated adenocarcinoma. A preoperative diagnosis of synchronous double cancer of the bile duct and lung was made.It was judged impossible to resect the both carcinomas on an one-step approach in terms of surgical invasion. Intra-arterial infusion therapy with CDDP via the left bronchial artery was performed for the lung carcinoma, followed by left lower lobectomy with combined resection of the chest wall and ribs 42 days after pancreato-duodenectomy.It is generally accepted that we must give a surgical priority to the more advanced cancer responsible for the prognosis of the patient carrying synchronous double cancer.Multidisciplinary treatment and aggresive surgical intervention may bring the patient a long-term survival and favorable prognosis.