Left Hepatectomy (Réglée) for Cholangiocarcinoma Occurring 5 Years after Gastrectomy for Adenocarcinoma – Case Report

Abstract

Background

Intrahepatic cholangiocarcinoma is an aggressive primary cancer of the liver with limited systemic therapeutic options. Surgical resection may be the only feasible option. It has an overall low incidence among gastrointestinal tumours (3%), and is the second most common cancer of the liver after hepatocellular type.

Most patients diagnosed are asymptomatic, however the most common complaint is abdominal pain and other less common non-specific symptoms such as weight loss.

Case presentation

Our patient is a 72 years old male with the following medical history and presentation: 5 years prior he is diagnosed with adenocarcinoma of the stomach, antro-pyloric region. A 4/5 gastric resection and gastro-entero anastomosis, Braun anastomosis with D2 lymphatic curage without splenectomy was performed. Examinations show a hepatic lesion of segments II – III. A fibrogastroscopy and colonoscopy result normal.

By means of puncture-biopsy a diagnosis of cholangiocarcinoma is established. The patient undergoes a left hepatectomy (Réglée) after he receives a chemotherapy course. His post-operative course was uneventful and was discharged in good health.

Discussion

This specific case posed a diagnostic challenge, knowing his past history for adenocarcinoma of the stomach 5 years prior. Abdominal pain and weight loss lead to a cross sectional imaging detection of a hypovascular lesion of liver segments II – III. Careful evaluation with gastroscopy and colonoscopy, along with puncture biopsy was needed to determine whether it was a metastasis or a primary tumour. In contrast to other intrahepatic tumors like hepatocellular carcinoma, therapeutic methods for intrahepatic cholangiocarcinoma are still being developed due to its rarity. Hepatic resection does, however, have a most important place in the treatment of patients.

Conclusion

Intra-hepatic cholangiocarcinoma remains a difficult condition in terms of diagnosis, surgical decision-making and survivability. However multiple studies confirm the role of surgical resection R0 with lymphadenectomy. Lymphatic permeation, vascular invasion, and intrahepatic satellite lesions were acknowledged as predictors of poor survival. Other treatment options such as chemotherapy and tumor ablation or embolization are still controversial with respect to their survival benefit, but can provide a role in select cases.

Keywords: General Surgery, Hepatobiliary Surgery, Cholangiocarcinoma, Adenocarcinoma, Hepatectomy.

DOI: 10.7176/JEP/14-5-04

Publication date: February 28^th 2023