A 67-year-old male patient was diagnosed with
intrahepatic cholangiocarcinoma with para-aortic
metastases [cT2N1M1, stage IVB]. He was enrolled in our phase II study for unresectable BTC consisting of
cisplatin (25 mg/m2 i.v. for 30 min) followed by
gemcitabine (1000 mg/m2 i.v. for 30 min) on days 1 and 8 and oral S-1 on alternate days. After 8 courses of this regimen, marked regression of para-aortic lymph
metastases was achieved, and we performed extended left hepatic lobectomy with the caudate lobe, concomitant portal vein resection, and
lymph node dissection including the para-aortic region. The patient made a satisfactory recovery and was discharged on postoperative day 25. Histopathological examination revealed more than 50% of the
tumor area replaced with
fibrosis, and curative resection was achieved (ypT2N1M1, stage IVB, Evans criteria IIb). The patient received
adjuvant chemotherapy using S-1 for 12 months and remains well with no evidence of
tumor recurrence as of 48 months after surgery.
CONCLUSIONS: