Case Report
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World J Gastroenterol. Mar 21, 2014; 20(11): 3050-3055
Published online Mar 21, 2014. doi: 10.3748/wjg.v20.i11.3050
Classifying extrahepatic bile duct metachronous carcinoma by de novo neoplasia site
Hyung Jun Kwon, Sang Geol Kim, Jae Min Chun, Yoon Jin Hwang
Hyung Jun Kwon, Sang Geol Kim, Yoon Jin Hwang, Department of Surgery, Kyungpook National University Medical Center, Daegu 702-210, South Korea
Jae Min Chun, Department of Surgery, School of Medicine, Kyungpook National University, Daegu 700-721, South Korea
Author contributions: Kwon HJ was the first author and composed the majority of the manuscript; Chun JM prepared the literature review; Hwang YJ designed and coordinated the study and helped to draft the manuscript; Kim SG was the corresponding author and performed the surgery in addition to initiating and guiding the program of disease classification in the study; all authors have read and approved the final manuscript.
Supported by Kyungpook National University Research Fund, 2013
Correspondence to: Sang Geol Kim, MD, Department of Surgery, Kyungpook National University Medical Center, 807 Hogukno, Buk-gu, Daegu 702-210, South Korea. ksg@knu.ac.kr
Telephone: +82-53-2002703 Fax: +82-53-2002027
Received: October 1, 2013
Revised: December 4, 2013
Accepted: January 3, 2014
Published online: March 21, 2014
Processing time: 167 Days and 17.7 Hours
Abstract

Extrahepatic bile duct (EHBD) cancer may occur metachronously, and these cancers are resectable with a favorable prognosis. We aimed to identify the pattern of metachronous EHBD cancer. We classified the cases of metachronous EHBD cancer reported in the literature thus far and investigated two new cases of metachronous EHBD cancer. A 70-year-old female underwent R0 bile duct resection for a type 1 Klatskin tumor (pT1N0M0). A 70-year-old male patient underwent R0 bile duct resection for a middle bile duct cancer (pT2N1M0). Imaging studies of both patients taken at 14 and 24 mo after first surgery respectively revealed a metachronous cholangiocarcinoma that required pancreaticoduodenectomy (PD). Histopathology of the both tumors after PD revealed cholangiocarcinoma invading the pancreas (pT3N0M0). Both patients have been free from recurrence for 6 years and 16 mo respectively after the second surgery. Through a review of the literature on these cases, we classified the pattern of metachronous EHBD cancer according to the site of de novo neoplasia. The proximal remnant bile duct was most commonly involved. Metachronous EHBD cancer should be distinguished from an unresectable recurrent tumor. Classifying metachronous EHBD cancer may be helpful in identifying rare metachronous tumors.

Keywords: Metachronous; Extrahepatic bile duct; Cancer; Prognosis; Recurrence

Core tip: The cases of metachronous double bile duct cancer described emphasize the importance of differentiating this condition from a loco-regional recurrence. It is not a progression of the initial tumor but rather a new tumor. Therefore, it may have a good prognosis. The cases that have been reported thus far have shown a favorable prognosis. Tumor classification may be valuable during the long-term follow up after the initial surgery because it allows prediction of the potential site and proper surgical methods for the new tumors. Diagnosing these tumors and classifying their patterns may allow physicians the opportunity to cure the disease.