A Case of Re-Resection for Recurrence in the Abdominal Wall and Peritoneal Dissemination of the Hilar Cholangiocarcinoma

We report a case of prolonged survival after treatment for recurrence of hilar cholangiocarcinoma found in the abdominal wall, with peritoneal dissemination, almost 2 years after primary excision. A 65-year-old woman presented with epigastric discomfort and investigations revealed hilar cholangiocarcinoma invading the left branch of the portal vein. She underwent extended left hepatic lobectomy with excision of the caudate lobe and extrahepatic bile duct, and was discharged after an uneventful recovery, on postoperative day (POD) 25. A follow-up computed tomography (CT) scan 22 months later, identified a recurrent lesion 3 cm in size in the median abdominal wall. As there were no signs of other organs being involved, excision was performed. A solitary peritoneal dissemination 2 cm in size was identified in the greater omentum and excised at the same time. The patient was discharged on POD 11, and was prescribed 100 mg TS-1 per day orally, 4 weeks on, 2 weeks off. At the time of writing, 57 months after the first operation, the patient is well with no signs of further recurrent lesions. Recurrence of hilar cholangiocarcinoma is generally associated with a poor prognosis; however, this case shows that excision followed by chemotherapy for a solitary abdominal wall recurrence, even with peritoneal dissemination, can achieve long-term survival.