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Development of intrahepatic cholangiocarcinoma at the remnant intrahepatic cyst portion 10 years after resection of type IV choledochal cyst.

ABSTRACT: Complete resection of Todani type IV choledochal cyst (CC) is not possible, because the intrahepatic portion is not resectable. We present a case of intrahepatic cholangiocarcinoma that arose from the remnant CC portion that was located within the liver 10 years after resection. A 59-year-old female patient had undergone resection of type IV CC 10 years ago, leaving large remnant portions of CC at the liver and pancreas. Two and four years after resection of the extrahepatic CC, cholangitis with intrahepatic stones developed hence these episodes were treated with percutaneous transhepatic cholangioscopy. Ten years after the first operation, intrahepatic stones and a new mass were identified in follow-up imaging studies. Because the mass was identified as adenocarcinoma on biopsy, we performed left hepatectomy with redo hepaticojejunostomy. Pathologic examination showed a 4.5-cm-sized moderately differentiated adenocarcinoma arising from the remnant CC with lymph node metastasis. The patient recovered uneventfully and is currently undergoing adjuvant chemotherapy. Our case indicates that the remnant intrahepatic CC can undergo malignant transformation long after resection of CC. Since the intrahepatic CC portion in type IV CC is usually unresectable, wide hepaticojejunostomy and life-long observation with regular imaging study follow-up are highly recommended for prevention and early detection of malignant transformation.

SUBMITTER: Ha S

PROVIDER: S-EPMC7452807 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Development of intrahepatic cholangiocarcinoma at the remnant intrahepatic cyst portion 10 years after resection of type IV choledochal cyst.

Ha Suhyeon S Hwang Shin S Ryu Lee Na LN

Annals of hepato-biliary-pancreatic surgery 20200801 3

Complete resection of Todani type IV choledochal cyst (CC) is not possible, because the intrahepatic portion is not resectable. We present a case of intrahepatic cholangiocarcinoma that arose from the remnant CC portion that was located within the liver 10 years after resection. A 59-year-old female patient had undergone resection of type IV CC 10 years ago, leaving large remnant portions of CC at the liver and pancreas. Two and four years after resection of the extrahepatic CC, cholangitis with ...[more]

PMID: 32843607

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Project description:BACKGROUND:Intrahepatic cholangiocarinoma (ICC) has a rising incidence in western countries. Often major or extended resections are necessary for complete tumor removal. Due to demographical trends the number of elderly patients diagnosed with ICC is rising accordingly. Aim of this study is to show whether resection of ICC in elderly patients is reasonable or not. METHODS:Between January 2008 and June 2018 all consecutive patients with ICC were collected. Analyses were focussed on the performed resection, its extent, postoperative morbidity and mortality as well as survival. Statistics were performed with Chi2 test for categorical data and for survival analyses the Kaplan Meier model with log rank test was used. RESULTS:In total 210 patients underwent surgical exploration with 150 resections (71.4%). Patients were divided in 70-years cut-off groups (>?70 vs <?70?years of age) as well as a young (age 30-50, n?=?23), middle-age (50-70, n?=?76) and old (>?70, n?=?51) group, whose results are presented here. Resectability (p?=?0.709), extent of surgery (p?=?0.765), morbidity (p?=?0.420) and mortality (p?=?0.965) was comparable between the different age groups. Neither visceral (p?=?0.991) nor vascular (p?=?0.614) extension differed significantly, likewise tumor recurrence (p?=?0.300) or the localisation of recurrence (p?=?0.722). In comparison of patients > or?<?70?years of age, recurrence-free survival (RFS) was significantly better for the younger group (p?=?0.047). For overall survival (OS) a benefit could be shown, but without reaching significance (p?=?0.072). In subgroup analysis the middle-age group had significant better OS (p?=?0.020) and RFS (p?=?0.038) compared to the old group. Additionally, a better OS (p?=?0.076) and RFS (p?=?0.179) was shown in comparison with the young group as well, but without reaching significance. The young compared to the old group had analogous OS (p?=?0.931) and RFS (p?=?0.845). CONCLUSION:Resection of ICC in elderly patients is not associated with an increased perioperative risk. Even extended resections can be performed in elderly patients without obvious disadvantages. Middle-age patients have a clear benefit for OS and RFS, while young and old patients have a comparable and worse long-term outcome.

Dataset Information

Development of intrahepatic cholangiocarcinoma at the remnant intrahepatic cyst portion 10 years after resection of type IV choledochal cyst.

Publications

Development of intrahepatic cholangiocarcinoma at the remnant intrahepatic cyst portion 10 years after resection of type IV choledochal cyst.

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