재발된 간외담도계 암에 대한 근치적 재수술의 경험
The Results of curative Reoperation for Recurrent Cancer of the Extrahepatic Biliary Tract
윤유석, 정명희, 장진영, 조항영,
소속 상세정보
윤유석 ( )
서울대학교 의과대학 외과학교실
정명희 ( )
서울대학교 의과대학 외과학교실
장진영 ( )
서울대학교 의과대학 외과학교실
조항영 ( )
서울대학교 의과대학 외과학교실
KMID : 0371320030650050467
Abstract
Purpose: Local recurrence, following a resection for cancer of the gallbladder (GB) and bile duct, is usually incurable;
with 2nd curative surgery being almost impossible. To determine the feasibility and significance of 2nd curative surgery, our experiences are presented in this study.
Methods: The medical records and clinical outcomes of 4 patients that underwent a re-resection for recurrent cancer of the extrahepatic biliary tract were retrospectively reviewed.
Results: The mean age of the four patients was 51.5 years. One patient that had a recurrent disease at the intrahepatic and intrapancreatic bile duct, 66 months after a segmental resection of the bile duct for common bile duct (CBD) cancer, underwent a hepatopancreatoduodenectomy. The second patient had a recurrent tumor mass in the CBD originating from in a cystic duct, 11 months after a cholecystectomy, and underwent a segmental resection of the bile duct. The third patient had a recurrent disease in the distal CBD, 28 months after a right hepatectomy for a Klatskin tumor, and underwent a pylorus-preserving pancreatoduodenectomy. The gross type of the above 3 cases was a papillary tumor. The fourth patient had a recurrent tumor mass of the liver parenchyma, close to the previous resection margin, 16 months after a cholecystectomy and wedge resection of the GB bed at another hospital for GB cancer, and underwent a wider wedge resection of the GB bed.
There were no operative mortalities or morbidities. All patient are still alive after 46, 63, 9 and 30 months, respectively, without recurrence after the reoperation.
Conclusion: It is concluded that a surgical re-resection is possible in selected patients with recurrent bile duct cancer, mostly of the papillary type. A primary operation for bile duct cancer should be performed with a wide surgical margin, and secondary curative surgery should be considered whenever possible in cases of recurrence.
키워드
간외담관암;담낭암;재발;재절제술;Extrahepatic bile duct cancer;GB cancer;Recurrence;Re-resection
원문 및 링크아웃 정보
등재저널 정보