Abstract:

BACKGROUND: Because of the specificity and complexity of hepatic portal, carcinoma of bile duct of the hepatic portal is a difficulty in the surgical treatment.
OBJECTIVE: To evaluate the safety and feasibility of simultaneous pancreaticoduodenectomy and liver transplantation for the end-stage hilar cholangiocarcinoma.
METHODS: One recipient diagnosed as hilar cholangiocarcinoma (Bismuth type Ⅳ), with lymph node metastasis of hilar region and that posterior to pancreatic head, received pancreaticoduodenectomy combined with liver transplantation. During the initial period of post-operation, steroid, tacrolimus and mycophenolate mofetil were supplied, and the steroid was used with lower dose than normal and quickly retreated. The parameters of liver and pancreatic functions, and CA19-9 were observed postoperatively.
RESULTS AND CONCLUSION: Pathology demonstrated a middle or low differentiation of hilar cholangiocarcinoma, and left, right hepatic duct, together with lobus quadratus were invaded. The tumor metastasized to hilar and posterior pancreatic lymphonodes, without involving the head of pancreas, duodenum and stomach. The function of transplanted liver recovered smoothly, and the endocrine and exocrine functions of pancreas were kept well. CA19-9 dropped to the normal levels. The patient recovered and discharged at 1 month after surgery, and still survived after one year follow up. These suggest that simultaneous pancreaticoduodenectomy and liver transplantation as a treatment of hilar cholangiocarcinoma are safe and feasible.