A 2-year-old surviving case of mucinous-carcinoma of the common bile duct by extended pancreaticoduodenectomy with combined resection of the hepatic artery, portal vein and inferior vena cava

The patient was a 72-year-old male who had undergone endoprosthesis of the Strecker-stent for stenosis of the common bile duct after surgery of the gastric cancer. Lateral segmentectomy with hepatico-jejunostomy underwent for recurrence of obstructive jaundice following the prosthesis. He was admitted to our hospital complaining of fever, back pain and general fatigue. Endoscopic retrograde cholangiography demonstrated stenosis of the intrapancreatic bile duct and periampullary dilatation. A computed tomography (CT) had revealed minimally progression in linear measurement for the tumor during 10 months after admission. Stenosis and deviation of the hepatic inflow vessels and inferior vena cava were noted on the angiogram. Because it was diagnosed that stenosis of the common bile duct was not caused by the cancer but the primary bile duct cancer, the patient underent extended pancreaticoduodenectomy with combined vana cava. Histological findings of the tumor were mucinous adenocarcinoma, which involved the pancreas head and invaded the duodenum. Ten months after the operation, liver metastasis of the tumor was detected by CT, but it became indetectable after the percutaneus ethanol injection therapy (PEIT). The patient is achieving a tumor-free survival for 14 months with a better quality of life. Mucinous adenocarcinoma of the common bile duct is not so common in literature. In the therapy of the mucinous histological subtype, active surgical approach may improve the prognosis of advanced common bile duct cancer.