Background : Although ampulla of Vater (AoV) cancer shows a relatively good prognosis among periampullary tumors, not a few patients with AoV cancer are diagnosed at an advanced stage. For these patients, there is no established treatment known to be effective yet. We report a case of long-term survival after liver metastatectomy and sequential palliative chemotherapy for AoV cancer with single liver metastasis.

Methods : A 62-year-old woman who complained of dark urine for 3 to 4 days was referred. She also had 3-4 kg weight loss for a month and decreased appetite. On detailed examination including CT, a heterogenous mass about 2 cm in periampullary area with single 2 cm-sized lobulated lesion at hepatic S8 subcapsular area was detected. Endoscopic Bx for AoV mass revealed tubulovillous adenoma with high grade dysplasia, but percutaneous approach for the liver mass was not possible due to the location of liver dome. The liver lesion was proved to be metastatic adenocarcinoma through metastatectomy and frozen Bx. After implantation of a self-expanding metallic stent, the patient underwent chemotherapy; six cycles of gemcitabine (1000 mg/BSA, D1, D8) plus cisplatin (60mg/BSA, D1) was conducted.

Results : Although the metal stents were reinserted for dislocation several times, there was no significant progression of AoV cancer for 4 years after completion of chemotherapy. Then, a low-density mass of about 1.7 cm in size was found in the liver for the first time on a regular follow-up CT scan. However, no additional chemotherapy was available for recurrence due to the patient's poor general condition and the liver masses gradually increased in size. The patient has been receiving supportive care with alternating inpatient and outpatient visits for 8 months.

Conclusions : Metastatectomy followed by palliative chemotherapy with gemcitabine plus cisplatin could prolong the survival duration in selected patients with AoV cancer and liver metastasis.