Pancreatoduodenectomy for local intrapancreatic recurrence after bile duct resection of mid bile duct carcinoma

Cancers originating from the proximal and mid portions of the common bile duct exhibit a variable degree of longitudinal tumor spread, thus curative resection with attainment of sufficient resection margins is often difficult to achieve. Not surprisingly, local tumor recurrence after noncurative resection occurs frequently, but most recurrences are not considered viable indications for a second operative intervention. We describe our experience of attempting to achieve curative repeat resection after local recurrence of bile duct carcinoma. Two male patients, aged 49 and 58 years, had localized tumor recurrence in the intrapancreatic bile duct 25 and 43 months after segmental bile duct resection for proximal-to-mid duct carcinoma. Following close observation for 3-4 months to determine operability, these 2 patients underwent pylorus-preserving pancreatoduodenectomy, in which both pre-existing hepaticojejunostomy and Roux jejunal limb were effectively used. There was no further recurrence for 65 and 37 months after repeat resection, respectively. Repeat resection with pancreatoduodenectomy may be a feasible treatment modality for selected patients showing late intrapancreatic recurrence after prior segmental bile duct resection.