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Clinical significance of reconstruction of the right hepatic artery for biliary malignancy

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Abstract

Background and aims

The clinical significance of resectional surgery with reconstruction of the right hepatic artery for biliary malignancy remains unclear.

Patients/methods

Between 1990 and 2004, six patients (5%) with cholangiocarcinoma and five patients (3%) with gallbladder carcinoma with possible involvement of the right hepatic artery underwent resectional surgery with reconstruction of the right-sided hepatic artery. The surgical procedures included extended left hemihepatectomy (n=4), left trisectionectomy (n=1), central bisegmentectomy (n=1), resection of anterior segment and inferior area of segment 4 (n=2), resection of segment 5 and inferior area of segment 4 (n=1), and extrahepatic bile duct resection (n=2). Segmental resection and reconstruction of the right (n=7), anterior (n=1), or posterior (n=3) hepatic artery was performed by end-to-end anastomosis (n=5), using the right gastroepiploic artery (n=4), the gastroduodenal artery (n=1), or an autologous venous graft (n=1).

Results

There was no in-hospital mortality. Histopathological arterial involvement was present in seven patients, and the surgical margin was positive in five patients. The median survival was 23 months in R0 patients (n=6), while it was 13 months in R1 patients (n=5) (p=0.16).

Conclusion

Reconstruction of the right hepatic artery was safely performed in patients with biliary malignancy. Arterial reconstruction can be indicated when the arterial involvement is the only obstacle to obtain negative surgical margins.

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Acknowledgements

Supported in part by a Grant-in-Aid for scientific research from the Ministry of Education, Science, and Culture, and the Ministry of Health and Welfare of Japan.

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Authors and Affiliations

  1. Hepatobiliary and Pancreatic Surgery Division, Department of Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Yoshihiro Sakamoto, Tsuyoshi Sano, Kazuaki Shimada & Tomoo Kosuge

  2. Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan

    Yoshihiro Kimata

  3. Plastic and Reconstructive Surgery Division, National Cancer Center Hospital East, Tokyo, Japan

    Minoru Sakuraba

  4. Department of Gastrointestinal Surgery, Cancer Institute Hospital, Tokyo, Japan

    Junji Yamamoto

  5. Division of Pathology, National Cancer Center Research Institute, Tokyo, Japan

    Hidenori Ojima

Authors
  1. Yoshihiro Sakamoto
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  2. Tsuyoshi Sano
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  3. Kazuaki Shimada
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  4. Tomoo Kosuge
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  5. Yoshihiro Kimata
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  6. Minoru Sakuraba
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  7. Junji Yamamoto
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  8. Hidenori Ojima
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Correspondence to Yoshihiro Sakamoto.

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Sakamoto, Y., Sano, T., Shimada, K. et al. Clinical significance of reconstruction of the right hepatic artery for biliary malignancy. Langenbecks Arch Surg 391, 203–208 (2006). https://doi.org/10.1007/s00423-006-0026-8

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  • DOI: https://doi.org/10.1007/s00423-006-0026-8

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