European Surgery

, Volume 51, Issue 1, pp 34–39 | Cite as

An aggressive surgical approach to rare central biliary invasion of colon cancer

  • Bibek Aryal
  • Kota Yoshikawa
  • Teruo KomokataEmail author
  • Hiroto Yasumura
  • Maki Inoue
  • Mamoru Kaieda
  • Yutaka Imoto
case report



Central biliary metastasis from colorectal cancer (CRC) is a rare manifestation. Given the rarity of the lesion, cases with central biliary metastasis from CRC pose challenges in identifying the proper treatment strategy.


We present a case of stage IV CRC with synchronous multiple liver metastases and central biliary invasion. We also conducted a literature search and reviewed the reports on central biliary metastasis of CRC treated by major hepatectomy combined with extrahepatic bile duct resection.


The patient underwent colon resection, partial hepatectomy, and transileocecal portal embolization (TIPE) as the first procedure, which was followed by an extended right hepatectomy and extrahepatic bile duct resection. Adjuvant chemotherapy was introduced, and the patient was doing well with no recurrence at 17 months after the first procedure.


A liberal radical and aggressive resection in a multimodal treatment strategy could offer a favorable outcome in patients with a rare central biliary manifestation of CRC.


Central biliary metastasis Colorectal cancer Prognosis Hepatectomy Aggressive surgical approach 


Conflict of interest

B. Aryal, K. Yoshikawa, T. Komokata, H. Yasumura, M. Inoue, M. Kaieda, and Y. Imoto declare that they have no competing interests.


  1. 1.
    Adam R, de Gramont A, Figueras J, et al. Managing synchronous liver metastases from colorectal cancer: a multidisciplinary international consensus. Cancer Treat Rev. 2015;41:729–41.PubMedCrossRefGoogle Scholar
  2. 2.
    Goey KK, ’t Lam-Boer J, de Wilt JH, et al. Significant increase of synchronous disease in first-line metastatic colorectal cancer trials: results of a systematic review. Eur J Cancer. 2016;69:166–77.PubMedCrossRefGoogle Scholar
  3. 3.
    Martin R, Paty P, Fong Y, et al. Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastasis. J Am Coll Surg. 2003;197:233–41. discussion 41–2.PubMedCrossRefGoogle Scholar
  4. 4.
    Estrella JS, Othman ML, Taggart MW, et al. Intrabiliary growth of liver metastases: clinicopathologic features, prevalence, and outcome. Am J Surg Pathol. 2013;37:1571–9.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Okano K, Yamamoto J, Moriya Y, et al. Macroscopic intrabiliary growth of liver metastases from colorectal cancer. Surgery. 1999;126:829–34.PubMedCrossRefGoogle Scholar
  6. 6.
    Povoski SP, Klimstra DS, Brown KT, et al. Recognition of intrabiliary hepatic metastases from colorectal adenocarcinoma. HPB Surg. 2000;11:383–90. discussion 90–1.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Koh FH, Shi W, Tan KK. Biliary metastasis in colorectal cancer confers a poor prognosis: case study of 5 consecutive patients. Ann Hepatobiliary Pancreat Surg. 2017;21:57–60.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Chedid AD, Chedid MF, Kruel CR, et al. Extended right hepatectomy with total caudate lobe resection and biliary tree resection for a large colorectal liver metastasis involving both the right and left hepatic lobes and the umbilical fissure: a case report. Am Surg. 2005;71:447–9.PubMedGoogle Scholar
  9. 9.
    Sano T, Kamiya J, Nagino M, et al. Pancreatoduodenectomy after hepato-biliary resection for recurrent metastatic rectal carcinoma. J Hepatobiliary Pancreat Surg. 2000;7:516–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Sudo N, Ishikawa H, Katada T, et al. Colorectal carcinoma liver metastasis with bile duct involvement difficult to differentiate from intrahepatic cholangiocarcinoma: report of two cases. J Niigata Med Assoc. 2014;128:269–75.Google Scholar
  11. 11.
    Takamatsu S, Teramoto K, Kawamura T, et al. Liver metastasis from rectal cancer with prominent intrabile duct growth. Pathol Int. 2004;54:440–5.PubMedCrossRefGoogle Scholar
  12. 12.
    Tomizawa N, Ohwada S, Tanahashi Y, et al. Liver metastasis of rectal cancer with intraluminal growth in the extrahepatic bile duct. Hepatogastroenterology. 2003;50:1625–7.PubMedGoogle Scholar
  13. 13.
    Uno M, Matsuzaki Y, Kamiya S, et al. Intrabiliary growth of metastatic adenocarcinoma 11 years after curative operation of colon cancer. Jpn J Gastroenterol Surg. 2016;49:15–21.CrossRefGoogle Scholar
  14. 14.
    Wenzel DJ, Gaede JT, Wenzel LR. Case report. Intrabiliary colonic metastasis mimicking primary biliary neoplasia. AJR Am J Roentgenol. 2003;180:1029–32.PubMedCrossRefGoogle Scholar
  15. 15.
    Wiggers JK, Te Riele WW, van Dongen TH, et al. Combined liver and extrahepatic bile duct resection for biliary invasion of colorectal metastasis: a case-cohort analysis and systematic review. Hepatobiliary Surg Nutr. 2016;5:350–7.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Yamaguchi NK, Kurumiya Y. Two resected liver metastases from rectal cancer with macroscopic intrabiliary tumor growths which collided in the right hepatic duct. Jpn J Gastroenterol Surg. 2015;48:1001–6.CrossRefGoogle Scholar
  17. 17.
    Kawakatsu S, Kaneoka Y, Maeda A, et al. Intrapancreatic bile duct metastasis from colon cancer after resection of liver metastasis with intrabiliary growth: a case report. World J Surg Oncol. 2015;13:254.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  • Bibek Aryal
    • 1
    • 2
  • Kota Yoshikawa
    • 1
  • Teruo Komokata
    • 1
    Email author
  • Hiroto Yasumura
    • 1
  • Maki Inoue
    • 1
  • Mamoru Kaieda
    • 1
  • Yutaka Imoto
    • 2
  1. 1.Department of Surgery, Kagoshima Medical CenterNational Hospital OrganizationKagoshimaJapan
  2. 2.Cardiovascular and Gastroenterological Surgery, Graduate School of Medical and Dental SciencesKagoshima UniversityKagoshimaJapan

Personalised recommendations