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Pancreatoduodenectomy after hepato‐biliary resection for recurrent metastatic rectal carcinoma
Author(s) -
Sano Tsuyoshi,
Kamiya Junichi,
Nagino Masato,
Kanai Michio,
Uesaka Katsuhiko,
Nimura Yuji
Publication year - 2000
Publication title -
journal of hepato‐biliary‐pancreatic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 0944-1166
DOI - 10.1007/s005340070024
Subject(s) - medicine , pancreaticoduodenectomy , metastasis , bile duct carcinoma , bile duct , anastomosis , whipple procedure , surgery , common bile duct , colorectal cancer , cancer , resection
Intrapancreatic bile duct metastasis from rectal carcinoma is rare. A 48‐year‐old man underwent extended left hepatic lobectomy and caudate lobectomy with extrahepatic bile duct resection for liver metastasis from a rectal carcinoma presenting with intrabiliary growth. A second recurrent tumor was successfully resected by pancreatoduodenectomy without injury to the jejunal loop for biliary reconstruction. Preservation of the previous bilio‐enteric anastomosis was critical. Placing the jejunal limb of the hepaticojejunostomy through the retrogastric route was superior to placement through the common retrocolic and anteduodenal route, because the mesentery of the Roux‐en Y jejunal limb did not obscure the pancreatic head. Histologic examination revealed a recurrent tumor growing into the remnant intrapancreatic bile duct. This suggested two possibilities: spontaneous shedding of cancer cells from the proximal metastasis, and implantation as a complication of percutaneous transhepatic biliary drainage. In both these circumstances, the metastatic lesion is not systemic, but is a local disease. An aggressive surgical approach for localized recurrence of this type may improve survival.