Two Stage Operations in a Patient with Recurrent Klatskin Tumor

ABSTRACT

BACKGROUND: Reoperation for recurrent bile duct cancer is almost impossible. We report here on a successfully managed case of recurrent Klatskin tumor. METHODS: A 45-year-old male was referred to our hospital with a relapsed Klatskin tumor 7 months after performing resection of his extrahepatic bile duct for Bismuth type I Klatskin tumor. The CT scan showed type IV Klatskin tumor with peritoneal dissemination. However, the PETCT scan didn't find any evidence of tumor. We decided to perform exploratory laparotomy to check the operability and confirm the diagnosis. RESULTS: No peritoneal dissemination was found during the first operation. After massive adhesiolysis, the jejunum was detached from the hepaticojejunostomy (HJ) site, and frozen biopsy confirmed adenocarcinoma at the strictured HJ site. The preoperatively measured left lateral sector was too small. Therefore, right trisectionectomy and caudate lobectomy were performed with keeping intact the right and left side inflow and outflow. HJ was performed in the normal B2 and B3 segments. Portal vein embolization (PVE) was done one week after the first operation. The volume of the left lateral sector increased three weeks after PVE. We safely and completely removed the right trisector and caudate lobe one month after the first operation. He recovered well and was discharged 4 weeks after the operation. No evidence of recurrence was found 14 months after the last operation. CONCLUSIONS: Although there is a possibility of severe adhesion and tumor spreading due to two-staged operation, this procedure may be one of the alternative methods to prevent liver failure that is due to an inadequate liver volume in the case of performing unexpected, extended liver resection. The authors also confirmed that curative resection was feasible to perform in selected cases of recurrent bile duct cancer.