Langenbeck's Archives of Surgery

, Volume 391, Issue 3, pp 203–208

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

  • Yoshihiro Sakamoto
  • Tsuyoshi Sano
  • Kazuaki Shimada
  • Tomoo Kosuge
  • Yoshihiro Kimata
  • Minoru Sakuraba
  • Junji Yamamoto
  • Hidenori Ojima
Original Article

DOI: 10.1007/s00423-006-0026-8

Cite this article as:
Sakamoto, Y., Sano, T., Shimada, K. et al. Langenbecks Arch Surg (2006) 391: 203. doi:10.1007/s00423-006-0026-8

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.

Keywords

Hepatic artery reconstructionBiliary malignancyRight gastroepiploic arterySurgical marginsArterial involvement

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Yoshihiro Sakamoto
    • 1
  • Tsuyoshi Sano
    • 1
  • Kazuaki Shimada
    • 1
  • Tomoo Kosuge
    • 1
  • Yoshihiro Kimata
    • 2
  • Minoru Sakuraba
    • 3
  • Junji Yamamoto
    • 4
  • Hidenori Ojima
    • 5
  1. 1.Hepatobiliary and Pancreatic Surgery Division, Department of SurgeryNational Cancer Center HospitalChuo-kuJapan
  2. 2.Department of Plastic and Reconstructive SurgeryOkayama University Graduate School of Medicine and DentistryOkayamaJapan
  3. 3.Plastic and Reconstructive Surgery DivisionNational Cancer Center Hospital EastTokyoJapan
  4. 4.Department of Gastrointestinal SurgeryCancer Institute HospitalTokyoJapan
  5. 5.Division of PathologyNational Cancer Center Research InstituteTokyoJapan