Yamada Mihoko, Arimoto Atsuki, Toyoda Yoshitaka, Watanabe Shinya, Aizu Keiji, Sato Fumiya, Fujieda Akinori, Yamaguchi Ryuzo
Division of Surgery, Kasugai Municipal Hospital, Aichi, Japan.
Surg Case Rep. 2019 Aug 20;5(1):135. doi: 10.1186/s40792-019-0693-7.
A few reports to date have described the effectiveness of surgical resection for recurrent intrahepatic cholangiocarcinoma (ICC). We report in this study a patient who achieved long-term survival after surgical resection for recurrent hepatic and pulmonary metastases of ICC.
A 62-year-old man was referred to our hospital for examination of a tumor in the left lobe of the liver. Computed tomography (CT) scans of the abdomen revealed a hypovascularized tumor, 30 mm in hepatic segment 2 (S2). The patient was diagnosed with a mass-forming type of ICC. A left lateral sectionectomy with regional lymph node dissection was performed. Histopathological examination showed moderately differentiated adenocarcinoma in the hepatic S2 with lymph node metastasis. There were two intrahepatic metastases around the main tumor. The pathological stage of the ICC was pT2pN1M0pStageIIIB. The patient did not receive adjuvant chemotherapy after surgery. Twelve months after surgery, liver lesions in S4/S8 and S7 were detected on CT scans. A partial hepatectomy was performed. The histopathological features were similar to those of the previous ICC. The patient did not receive adjuvant chemotherapy after the repeat hepatectomy. Four years and four months after this repeat hepatectomy, CT scans showed multiple nodes in S4 and S10 of the left lung and in S1 of the right lung. Wedge resection of the left upper lobe and sectionectomy in S10 of the left lung were performed. Histopathological findings of the resected lung nodules were compatible with metastatic ICC. The nodule in S1 of the right lung was too small to be diagnosed as metastasis; therefore, it was not resected. After pulmonary resection, the patient was treated with gemcitabine and cisplatin for 6 months. After chemotherapy, the size of the nodule in S1 increased gradually. One year and ten months after the pulmonary resection, we performed wedge resection of S1 of the right lung, and the histopathological findings were compatible with metastatic ICC. The patient is alive without evidence of disease 8 years after the initial surgery and 8 months after the last pulmonary resection.
ICC with poor prognostic factors can frequently recur; however, surgical resection for recurrent ICC might, for selected patients, enable long-term survival.
迄今为止，有少数报告描述了手术切除复发性肝内胆管癌（ICC）的有效性。我们在本研究中报告了一名患者，其在手术切除复发性肝和肺转移的ICC后实现了长期生存。
一名62岁男性因肝脏左叶肿瘤检查被转诊至我院。腹部计算机断层扫描（CT）显示一个血供不足的肿瘤，位于肝2段（S2），大小为30毫米。患者被诊断为肿块型ICC。行左外侧叶切除术及区域淋巴结清扫术。组织病理学检查显示肝S2为中度分化腺癌伴淋巴结转移。主肿瘤周围有两个肝内转移灶。ICC的病理分期为pT2pN1M0pIII B期。患者术后未接受辅助化疗。术后12个月，CT扫描发现S4/S8和S7有肝脏病变。行部分肝切除术。组织病理学特征与先前的ICC相似。再次肝切除术后患者未接受辅助化疗。此次再次肝切除术后四年零四个月，CT扫描显示左肺S4和S10以及右肺S1有多个结节。行左上叶楔形切除术及左肺S10段切除术。切除的肺结节组织病理学结果与转移性ICC相符。右肺S1的结节太小，无法诊断为转移；因此，未予切除。肺切除术后，患者接受吉西他滨和顺铂治疗6个月。化疗后，S1结节大小逐渐增大。肺切除术后一年零十个月，我们对右肺S1行楔形切除术，组织病理学结果与转移性ICC相符。患者在初次手术后8年及最后一次肺切除术后8个月仍存活，无疾病证据。
具有不良预后因素的ICC常易复发；然而，对于部分患者，手术切除复发性ICC可能实现长期生存。
