[Two cases of lower bile duct recurrence resected by pancreatoduodenectomy after hepatectomy for hilar cholangiocarcinoma].

We report 2 rare cases of lower bile duct recurrence resected by pancreatoduodenectomy after hepatectomy for hilar cholangiocarcinoma. Case 1: A 74-year-old man underwent extended right hepatectomy for hilar cholangiocarcinoma (JSBS classification: pT1N0M0, fStage I, fCur A, negative cut end). The serum carbohydrate antigen 19-9 level was elevated 18 months after hepatectomy, but abdominal computed tomography showed no signs of recurrence. However, lower bile duct recurrence was revealed by subsequent magnetic resonance imaging, positron-emission tomography, and endoscopic retrograde cholangiopancreatography. Twenty months after hepatectomy, pancreatoduodenectomy was performed, and the pathological findings showed lower bile duct carcinoma(JSBS classification: pT3N0M0, fStage III, fCur A). The patient survived without recurrence 12 months after a secondary operation. Case 2: A 68-year-old woman underwent extended right hepatectomy for hilar cholangiocarcinoma(JSBS classification: pT3N2M0, fStage IVa, fCur B, negative cut end). Twelve months after hepatectomy, dilatation of the remaining lower bile duct was observed by abdominal computed tomography. Endoscopic retrograde cholangiopancreatography revealed lower bile duct stenosis with suspected malignancy, and positron-emission tomography scan detected increased fluorodeoxyglucose uptake at the stenosis. Fourteen months after the hepatectomy, pancreatoduodenectomy was performed and the pathological findings showed lower bile duct carcinoma(JSBS classification: pT4N2M0, fStage IVb, fCur B). The patient died of local recurrence 6 months after the secondary operation.