Major hepatectomy combined with pylorus-preserving pancreatoduodenectomy for middle bile duct cancer with multiple lymph node metastases: A case report of 5-year survival

Hepatopancreatoduodenectomy has been well established as an aggressive surg ical approach for advanced biliary tract malignancy. However, long-term sur vival of more than 5 years after this operation is rarely reported, especia lly with bile duct carcinoma. We report herein a 64 year-old man with middl e bile duct cancer who underwent extended right hepatectomy combined with p ylorus-preserving pancreatoduodenectomy because of widespread intramural ex tension of the tumor. Resection margin, which is considered the most signif icant prognostic parameter, was made clear only by additional hepatectomy i n this case. In addition, although microscopic examination revealed multipl e lymph node involvement up to the superior mesenteric node, the patient ha s survived 5 years and 6 months without tumor recurrence. It remains unclea r whether aggressive lymph node dissection may improve surgical outcome; ho wever, it is thought that surgical clearance of potentially involved nodes and tissue may be the only chance for long-term survival.