A Resected Case of Hilar Cholangiocarcinoma Effectively treated by Preoperative Radiation Therapy

Takao Nishimura, Yasuo Shima, Kazuhide Ozaki, Yuichi Shibuya, Toshio Nakamura, Madoka Hamada, Yasuo Fukui, Yutaka Nishioka, Toshikatu Taniki and Tadashi Horimi

Division of Digestive Surgery, Kochi Health Sciences Center

A seventysomething woman with general fatigue and liver dysfunction was found in computed tomography (CT) to have hilar cholangiocarcinoma. Endoscopic retrograde cholangiopancreatography (ERCP) indicated that a tumor occupied the left hepatic duct and spread to the bifurcation of the posterior and anterior branch of the right hepatic duct, necessitating hepatic trisegmentectomy was necessary to achieve margin negative resection and save margins for suturing. Because impaired liver function made the tumor unresectable as is, we conducted external-beam radiation of 30 Gy in 15 fractions, which was shown in CT and ERCP to reduce the tumor to a size, where we could conduct left hepatectomy with a negative surgical margin. Histological examination showed some carcinoma residue scattering at the confluence of the left and right hepatic duct. She was discharged in good health 16 days after surgery and has remained well for 7 the months since without sign of recurrence. We concluded that preoperative radiation therapy for cholangiocarcinoma is useful because it may convert an unresetable tumor to a resectable status.

Key words
cholangiocacinoma, preoperative chemoradiation, multi-disciplinary treatment

Reprint requests
Takao Nishimura Department of Surgery, Graduate School of Medicine Kyoto University
54 Shogoin-Kawahara cho, Sakyo, Kyoto, 606-8507 JAPAN

Accepted
January 28, 2009

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