Intraductal papillary neoplasm of the bile duct (IPNB) is a specific type of bile duct tumor. It has been proposed that it could be the biliary counterpart of the intraductal papillary neoplasm of the pancreas (IPMN-P). This hypothesis is supported by the presence of simultaneous intraductal tumors of both the bile duct and pancreas. There have been five reports of patients with simultaneous IPNB and IPMN-P. In all of these cases, biliary involvement was limited to the intrahepatic and perihilar bile duct, which had characteristics similar to IPMN-P and usually had slow progression in nature. Herein, we present the first case of extensive intraductal neoplasm involving the extrahepatic bile duct, intrahepatic bile duct, and entire length of the pancreas with a poor outcome, even after being treated aggressively with radical surgery and adjuvant chemotherapy. Additionally, we summarize previous case reports of simultaneous intraductal lesions of the bile duct and pancreas.

Background. Major hepatectomy is the mainstay of the treatment for cholangiocarcinoma. Infrahepatic inferior vena cava (IVC) clamping is an effective maneuver for reducing blood loss during liver transection. The impact of this procedure on major hepatectomy for cholangiocarcinoma is unknown. This study evaluated the effect of infrahepatic IVC clamping on blood loss during liver transection. Methods. Clinical and pathological data were collected retrospectively for 116 cholangiocarcinoma patients who underwent major hepatectomy between January 2015 and December 2016, to investigate the benefit of infrahepatic IVC clamping. Two of five surgeons adapted the policy performing infrahepatic IVC clamping during liver transection in all cases. Patients, therefore, were divided into those ( n = 39 ; 33.6%) who received infrahepatic IVC clamping during liver transection (C1) and those ( n = 77 ; 66.4%) who did not (C0). Results. The patients’ backgrounds, operative parameters, and extent of hepatectomy did not differ significantly between the 2 groups, except for gender. A significantly lower blood loss ( p = 0.028 ), blood transfusion ( p = 0.011 ), and rate of vascular inflow occlusion requirement ( p < 0.001 ) were observed in the C1 group. The respective blood losses in the C1 group and the C0 group were 498.9 (95% CI: 375.8-622.1) and 685.6 (95% CI: 571-800.2) millilitres. Conclusions. The current study found infrahepatic IVC clamping during liver transection for cholangiocarcinoma reduces blood loss, blood transfusion, and rate of vascular inflow occlusion requirement.

widely spreading biliary cancer often cause many complications. This study was aimed to analyze the outcome of HPD. Method: We reviewed retrospectively 51 patients who underwent HPD (45 with bile duct cancer, six with gallbladder cancer) and analyzed the surgical outcome. A value of ICG test (15min) and a size of the future remnant liver volume (FRLV) were utilized to judge tolerance of patients in consideration for undergoing each type of hepatectomy. Basically, portal vein embolization (PE) was performed in case of right hepatectomy or bilateral trisectionectomy on 2 or 3 weeks before HPD. Result: The patients underwent hepatectomy of two or more sectors. The median operative time was 723 [552e 989] minutes, intraoperative blood loss was 1860 [840e 6180] ml, and postoperative hospital stay was 57 [20e178] days. Thirty-one (61%) patients developed severe complications of grade IIIa or more in Clavien-Dindo classification. R0 resection was performed in 42 patients. Four patients have died during their hospital stay after HPD. Median survival time, 3-, and 5-year survival rates were 33 months, 48%, and 25%, respectively. The patient with lymph node positive (n=28) was significantly poor prognosis than the patient without lymph node positive. Median survival times were 48 months in the patient with metastatic lymph node and 27 months in the patients without metastatic lymph node, pathologically (p=0.020). Conclusion: Patients of biliary cancer with metastatic lymph node had a poor prognosis following HPD.

Objective: All types of cholangiocarcinoma (CCA) require a major hepatectomy, which has many post-operative complications. All complications usually present with persistent hyperbilirubinemia; however, studies on the prediction of post-operative hyperbilirubinemia after hepatectomy for patients with CCA are lacking. We evaluated the causes and patterns of persistent hyperbilirubinemia among the patients who underwent hepatectomy for CCA. Methods: We retrospectively reviewed the records of 216 CCA patients who underwent curative-intent hepatic resection between January 2015 and December 2016. We identified five patterns of hyperbilirubinemia for predicting the cause of persistent hyperbilirubinemia and the respective patient outcome. All clinical parameters and outcomes were analyzed for any significant associations. Results: Twenty-eight patients (24%) had post-operative persistent hyperbilirubinemia. Of these, liver failure was the most common cause (42.9%), followed by bile leakage (14.3%), then cholangitis (3.6%). Re-rising of the bilirubin level after post-operative day 3(the ‘V’ pattern), very well predicted liver failure. Moreover, this pattern was associated with poor survival of the patient. Conclusion: The current study provided a picture of persistent hyperbilirubinemia after hepatectomy for CCA. The proportion of post-operative liver failure was 12 percent. The pattern of serum bilirubin level could be used as a predictor of liver failure and long-term outcomes of CCA patients. The ‘V’ pattern was significantly associated with a high rate of liver failure and poor survival.

Highlight Luvira and colleagues present images of the intraoperative findings of Opisthorchis viverrini coexistent with intraductal papillary neoplasm of the bile duct. Along with evidence from previous reports, these findings suggest that Opisthorchis viverrini may play some role in the tumorigenesis of intraductal papillary neoplasm of the bile duct.