A Case Report of Reoperated Recurrent Cancer of Lower Bile Duct Following Pancreatoduodenectomy

Hayato Sugiura, Masahiro Suenaga, Yoshikatsu Okada, Yoshikazu Kokuba, Shinichi Uehara, Yoshihiro Ohwa

Department of Surgery, Nagoya Memorial Hospital

We encountered a patient in whom reoperation by means of total resection of the residual pancreas combined with splenectomy was possible 3 years after pancreatoduodenectomy (PD) for infiltrative cancer of the lower bile duct. The patient was a 60-year-old man diagnosed as having cancer of the lower bile duct and treated by PD who 3 years later developed generalized fatigue, weight loss, and was admitted. Thorough physical examination revealed recurrence of the patient's bile duct cancer, the lesion was judged operable on the basis of diagnostic imaging, and a combined reoperation consisting of resection of the residual pancreas and splenectomy was performed. On the basis of postoperative studies, it was concluded that the cancer recurred because of cancer cells, remaining in the pancreatic stump after the initial operation, formed a skip lesion via the pancreatic duct and grew 3 years later. The patient's postoperative course was favorable and his carcino-embryonic antigen level, which has been quite high preoperatively, fell to normal postoperatively. Nevertheless, local recurrence developed 6 months later, and the patient succumbed to carcinomatous peritonitis 7 months postoperatively.

Key words
reoperation after pancreato-duodenectomy, combined resection of the residual pancreas and spleen

Reprint requests
Hayato Sugiura Department of Surgery, Nagoya Memorial Hospital
4-305, Hirabari, Tenpaku-ku, Nagoya, 468 JAPAN

Accepted
January 8, 1992

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