A case of postoperative recurrent hilar cholangiocarcinoma in the lower bile duct treated with pancreatoduodenectomy]

When surgery is selected to treat postoperative recurrent hilar cholangiocarcinoma in the intrapancreatic bile duct, attention should be paid to the following: 1 ) technical resectability of the lesion, 2) reconstruction, and 3) high risk of complications. Eight cases, including the present case, of pancreatoduodenectomy (PD) for postoperative recurrent hilar cholangiocarcinoma in the intrapancreatic bile duct have been reported thus far. In October 2009, a 73-year-old man noticed that his stools were gray and visited a physician. He was diagnosed with cholangiocarcinoma on close examination and underwent left hepatic and caudate lobectomy in January 2010. After the surgery, he was treated with TS-1 (80 mg) and followed up at the outpatient clinic of our hospital. In July 2013, he was diagnosed with cancer of the lower bile duct and was admitted for surgery. The first and second pathological findings were carcinoma of the bile duct and papillary adenocarcinoma, respectively. The findings from the immunostaining were also inconsistent. The histopathological examination result suggested multicentric recurrence. The surgery was highly invasive, increasing the patient's risk of complications, in addition to the presence of postoperative adhesion. Therefore, surgery may be an important option for cases of localized recurrence but not for multicentric recurrence.