Repeated hepatectomy for recurrent intrahepatic cholangiocarcinoma

Repeated hepatectomy for remnant liver recurrence of primary intrahepatic cholangiocarcinoma (ICC) is a seldom-encountered surgical technique because of its poor prognosis. Here, we present two long-term survivors of recurrent ICC by repeated hepatectomy. One patient underwent five hepatectomies in 6 years; first, extended left hepatectomy for a primary mass-forming-type ICC and then four partial hepatectomies for independent recurrent tumors all developing in segment V. The other patient underwent re-hepatectomy for a very large recurrent tumor 7 years after the first left hepatectomy for a primary periductal-infiltrating-type ICC; and has survived for approximately 2 years from the second operation under hepatic arterial infusion chemotherapy. The recurrent tumor in the latter case arose in the segment IV remnant corresponding to the cut margin of the liver after the first inappropriate left hepatectomy. The mode of hepatic recurrence seemed closely related to the portal segmentation: in the first case, intrahepatic metastases via portal tributaries; and in the second, the occult residual cancer spreading widely through bile ductules.