A long term survival case of hilar cholangiocarcinoma with multiple metastases treated with chemotherapy and operation

A 40-year-old woman presenting with hilar cholangiocarcinoma and multiple liver metastases was admitted to our hospital. Initially, she underwent an extended right hepatectomy, 1 segmentectomy, and partial resection of the liver. After adjuvant chemotherapy with gemcitabine (1,000 mg/m² days 1,8, and 15, of a 28-day cycle), multiple liver metastases (1 lesion in S2 and 2 lesions in S4) were detected by computed tomography (CT). As a result of the impaired response to gemcitabine, the chemotherapy regimen was changed to include combined chemotherapy with gemcitabine (1,000 mg/m² days 1 and 8, of a 21-day cycle), and S-1 (120 mg/body/day days 1 through 14). After 5 courses of combined chemotherapy, the liver metastases reduced in size; subsequently, a left internal sectionectomy and radiofrequency ablation were performed. Thereafter, the patient continued to receive adjuvant chemotherapy with S-1 for an additional 3 years; she is alive, without recurrence, 5 years after the initial operation. We propose that aggressive surgery should be considered for patients presenting with chemotherapy-responsive cholangiocarcinoma with multiple metastases.