[Four Cases of Hepatectomy for Liver Metastases of Intractable Hepatobiliary Pancreatic Cancers].

The treatment of recurrences that occur after radical resection of intractable hepatobiliary pancreatic cancers such as intrahepatic cholangiocarcinoma, pancreatic carcinoma, and biliary tract carcinoma is more difficult than the treatment of primary lesions. In our institute, chest and abdominal CT examinations after radical resection of intractable hepatobiliary pancreatic cancers are performed about 3 times a year in order to evaluate for the possible emergence of small nodules in the liver. Instead of performing hepatectomy immediately after detecting small nodules, we conduct observations essentially for 3 to 6 months. Meanwhile, if the number of metastatic lesions tends to increase and absence of spread to other organs is confirmed, we decide to perform hepatectomy. In particular, when the detected nodule is solitary and larger than 1 cm, immediate hepatectomy is considered. We present the following 4 cases of hepatectomy for liver metastases after radical resection of intractable hepatobiliary pancreatic cancers: intrahepatic cholangiocarcinoma (n=1), gallbladder carcinoma (n=1), and pancreatic carcinoma (n=2). Liver metastases were detected at 3 to 17 months after radical resection of the primary lesion. Hepatectomy for the liver metastases was performed 14 to 18 months after the primary resection. Survival after hepatectomy was 22 to 45 months. The median survival was more than 25 months. By carefully selecting the indication for surgery, good results were obtained after hepatectomy even in cases of intractable cancers.