Case Report
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World J Gastroenterol. Oct 28, 2013; 19(40): 6934-6938
Published online Oct 28, 2013. doi: 10.3748/wjg.v19.i40.6934
Adjuvant surgery for advanced extrahepatic cholangiocarcinoma
Yukio Oshiro, Kazuhiro Takahashi, Ryoko Sasaki, Tadashi Kondo, Shingo Sakashita, Nobuhiro Ohkohchi
Yukio Oshiro, Kazuhiro Takahashi, Ryoko Sasaki, Tadashi Kondo, Nobuhiro Ohkohchi, Department of Surgery, Division of Gastroenterological and Hepatobiliary Surgery, and Organ Transplantation, University of Tsukuba, Tsukuba 305-8575, Japan
Shingo Sakashita, Department of Pathology, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
Author contributions: All authors made substantial contributions to the acquisition, analysis, and interpretation of data and participated in writing the paper; Ohkohchi N gave final approval of the version to be published.
Correspondence to: Yukio Oshiro, MD, PhD, Department of Surgery, Division of Gastroenterological and Hepatobiliary Surgery, and Organ Transplantation, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan. oshiro@md.tsukuba.ac.jp
Telephone: +81-29-8533221 Fax: +81-29-8533222
Received: June 27, 2013
Revised: August 4, 2013
Accepted: August 16, 2013
Published online: October 28, 2013
Processing time: 138 Days and 11.8 Hours
Abstract

Patients with Stage IV cholangiocarcinoma are currently not considered to be surgical candidates and are typically offered systemic chemotherapy. Recently, several novel systemic chemotherapy regimens have allowed an initially unresectable cholangiocarcinoma to be resectable. The aim of this article is to present the usefulness of adjuvant surgery in a case of advanced cholangiocarcinoma that was successfully treated with gemcitabine. A 72-year-old man was diagnosed with distal cholangiocarcinoma with liver metastases (cT2N0M1, Stage IV). He underwent metal stent placement in the duodenum to alleviate jaundice. After 18 courses of chemotherapy using gemcitabine without severe drug toxicities, a computed tomography scan showed that the liver metastases in S6 and S7 had disappeared. The patient underwent subtotal stomach-preserving pancreaticoduodenectomy and lymph node dissection. The pathological stage was pT2N0M0, Stage IB. The patient underwent 6 cycles of adjuvant chemotherapy using gemcitabine. The patient is alive and well 6 years and 9 mo after the diagnosis.

Keywords: Extrahepatic cholangiocarcinoma; Adjuvant surgery; Conversion surgery; Chemotherapy; Gemcitabine

Core tip: Patients with Stage IV cholangiocarcinoma are currently not considered to be surgical candidates and are typically offered systemic chemotherapy. Recently, several novel systemic chemotherapy regimens have allowed an initially unresectable cholangiocarcinoma to be resectable. In a patient with advanced extrahepatic cholangiocarcinoma, gemcitabine (GEM) induced a dramatic reduction of the tumor, which led to curative resection and a long-term survival of 6 years and 9 mo. This result suggests the possibility of advantages of using GEM for the treatment of advanced cholangiocarcinoma, and GEM-based chemotherapy could be performed more often for unresectable cholangiocarcinomas.