Skip to main content

Advertisement

SpringerLink
Log in

Isolated caudate lobectomy with pancreatoduodenectomy for a bile duct cancer

  • How-I-Do-It article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Background

In patients with distal bile duct cancer involving the hepatic hilus, a major hepatectomy concomitant with pancreatoduodenectomy (HPD) is sometimes ideal to obtain a cancer-free resection margin. However, the surgical invasiveness of HPD is considerable.

Patients and methods

We present our treatment option for patients with distal bile duct cancer showing mucosal spreading to the hepatic hilum associated with impaired liver function. To minimize resection volume of the liver, an isolated caudate lobectomy (CL) with pancreatoduodenectomy (PD) using an anterior liver splitting approach is presented. Liver transection lines and bile duct resection points correspond complete with our standard right and left hemihepatectomies with CL for perihilar cholangiocarcinoma.

Results

Total operation time was 765 min, and pedicle occlusion time was 124 min, respectively. Although the proximal mucosal cancer extension was identified at both the right and the left hepatic ducts, all resection margins were negative for cancer.

Conclusions

Isolated CL with PD is an alternative radical treatment option for bile duct cancer patients with impaired liver function.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Seyama Y, Kubota K, Sano K, Noie T, Takayama T, Kosuge T, Makuuchi M (2003) Long-term outcome of extended hemihepatectomy for hilar bile duct cancer with no mortality and high survival rate. Ann Surg 238:73–83

    PubMed  Google Scholar 

  2. Kawasaki S, Imamura H, Kobayashi A, Noike T, Miwa S, Miyagawa S (2003) Results of surgical resection for patients with hilar bile duct cancer: application of extended hepatectomy after biliary drainage and hemihepatic portal vein embolization. Ann Surg 238:84–92

    PubMed  Google Scholar 

  3. Kondo S, Hirano S, Ambo Y, Tanaka E, Okushiba S, Morikawa T, Katoh H (2004) Forty consecutive resections of hilar cholangiocarcinoma with no postoperative mortality and no positive ductal margins: results of a prospective study. Ann Surg 240:95–101

    Article  PubMed  Google Scholar 

  4. Nagino M, Kamiya J, Nishio H, Ebata T, Arai T, Nimura Y (2006) Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer: surgical outcome and long-term follow-up. Ann Surg 243:364–372

    Article  PubMed  Google Scholar 

  5. Sano T, Shimada K, Sakamoto Y, Yamamoto J, Yamasaki S, Kosuge T (2006) One hundred two consecutive hepatobiliary resections for perihilar cholangiocarcinoma with zero mortality. Ann Surg 244:240–247

    Article  PubMed  Google Scholar 

  6. Nimura Y, Hayakawa N, Kamiya J, Kondo S, Shionoya S (1990) Hepatic segmentectomy with caudate lobe resection for bile duct carcinoma of the hepatic hilus. World J Surg 14:535–544

    Article  PubMed  CAS  Google Scholar 

  7. Kow AW, Wook CD, Song SC, Kim WS, Kim MJ, Park HJ, Heo JS, Choi SH (2012) Role of caudate lobectomy in type III A and III B hilar cholangiocarcinoma: a15-year experience in a tertiary institution. World J Surg 36:1112–1121

    Article  PubMed  Google Scholar 

  8. Miyazaki M, Kimura F, Shimizu H, Yoshidome H, Otuka M, Kato A, Yoshitomi H, Furukawa K, Takeuchi D, Takayashiki T, Suda K, Takano S (2010) One hundred seven consecutive surgical resections for hilar cholangiocarcinoma of Bismuth types II, III, IV between 2001 and 2008. J Hepatobiliary Pancreat Sci 17:470–475

    Article  PubMed  Google Scholar 

  9. Unno M, Katayose Y, Rikiyama T, Yoshida H, Yamamoto K, Morikawa T, Hayashi H, Motoi F, Egawa S (2010) Major hepatectomy for perihilar cholangiocarcinoma. J Hepatobiliary Pancreat Sci 17:463–469

    Article  PubMed  Google Scholar 

  10. Young AL, Prasad KR, Toogood GJ, Lodge JP (2010) Surgical treatment of hilar cholangiocarcinoma in a new era: comparison among leading Eastern and Western centers, Leeds. J Hepatobiliary Pancreat Sci 17:497–504

    Article  PubMed  Google Scholar 

  11. Lee SG, Song GW, Hwang S, Ha TY, Moon DB, Jung DH, Kim KH, Ahn CS, Kim MH, Lee SK, Sung KB, Ko GY (2010) Surgical treatment of hilar cholangiocarcinoma in the new era: the Asan experience. J Hepatobiliary Pancreat Sci 17:476–489

    Article  PubMed  Google Scholar 

  12. Hirano S, Kondo S, Tanaka E, Shichinohe T, Tsuchikawa T, Kato K, Matsumoto J, Kawasaki R (2010) Outcome of surgical treatment of hilar cholangiocarcinoma: a special reference to postoperative morbidity and mortality. J Hepatobiliary Pancreat Sci 17:455–462

    Article  PubMed  Google Scholar 

  13. Igami T, Nishio H, Ebata T, Yokkoyama Y, Sugawara G, Nimura Y, Nagino M (2010) Surgical treatment of hilar cholangiocarcinoma in the “new era”: the Nagoya University experience. J Hepatobiliary Pancreat Sci 17:449–454

    Article  PubMed  Google Scholar 

  14. Rocha FG, Matsuo K, Blumgart LH, Jarnagin WR (2010) Hilar cholangiocarcinoma: the Memorial Sloan–Kettering Cancer Center experience. J Hepatobiliary Pancreat Sci 17:490–496

    Article  PubMed  Google Scholar 

  15. Neuhaus P, Jonas S, Bechstein WO, Lohmann R, Radke C, Kling N, Wex C, Lobeck H, Hintze R (1999) Extended resections for hilar cholangiocarcinoma. Ann Surg 230:808–818

    Article  PubMed  CAS  Google Scholar 

  16. Hemming AW, Reed AI, Fujita S, Foley DP, Howard RJ (2005) Surgical management of hilar cholangiocarcinoma. Ann Surg 241:693–702

    Article  PubMed  Google Scholar 

  17. Miyazaki M, Ito H, Nakagawa K, Ambiru S, Shimizu H, Okaya T, Shinmura K, Nakajima N (1999) Parenchyma-preserving hepatectomy in the surgical treatment of hilar cholangiocarcinoma. J Am Coll Surg 189:575–583

    Article  PubMed  CAS  Google Scholar 

  18. Yamamoto J, Takayama T, Kosuge T, Yoshida J, Shimada K, Yamasaki S, Hasegawa H (1992) An isolated caudate lobectomy by the transhepatic approach for hepatocellular carcinoma in cirrhotic liver. Surgery 111:699–702

    PubMed  CAS  Google Scholar 

  19. Takayama T, Tanaka T, Higaki T, Katou K, Teshima Y, Makuuchi M (1994) High dorsal resection of the liver. J Am Coll Surg 179:72–75

    PubMed  CAS  Google Scholar 

  20. Yamamoto J, Kosuge T, Shimada K, Yamasaki S, Takayama T, Makuuchi M (1999) Anterior transhepatic approach for isolated resection of the caudate lobe of the liver. World J Surg 23:97–101

    Article  PubMed  CAS  Google Scholar 

  21. Miyazaki M, Kimura F, Shimizu H, Yoshidome H, Otsuka M, Kato A, Hideyuki Y, Nozawa S, Furukawa K, Mituhashi N, Takeuchi D, Suda K, Takano S (2008) Extensive hilar bile duct resection using a transhepatic approach for patients with hepatic hilar bile duct diseases. Am J Surg 196:125–129

    Article  PubMed  Google Scholar 

  22. Nimura Y, Hayakawa N, Kamiya J, Maeda S, Kondo S, Yasui A, Shionoya S (1991) Hepatopancreatoduodenectomy for advanced carcinoma of the biliary tract. Hepatogastroenterology 38:170–175

    PubMed  CAS  Google Scholar 

  23. Ebata T, Nagino M, Nishio H, Arai T, Nimura Y (2007) Right hepatopancreatoduodenectomy: improvements over 23 years to attain acceptability. J Hepatobiliary Pancreat Surg 14:131–135

    Article  PubMed  Google Scholar 

  24. Wakai T, Shirai Y, Tsuchiya Y, Nomura T, Akazawa K, Hatakeyama K (2008) Combined major hepatectomy and pancreaticoduodenectomy for locally advanced biliary carcinoma: long-term results. World J Surg 32:1067–1074

    Article  PubMed  Google Scholar 

  25. Kawakami H, Kuwatani M, Etoh K, Haba S, Yamato H, Shinada K, Nakanishi Y, Tanaka E, Hirano S, Kondo S, Kubota K, Asaka M (2009) Endoscopic retrograde cholangiography versus peroral cholangioscopy to evaluate intraepithelial tumor spread in biliary cancer. Endoscopy 41:959–964

    Article  PubMed  CAS  Google Scholar 

  26. Itoi T, Osanai M, Igarashi Y, Tanaka K, Kida M, Maguchi H, Yasuda K, Okano N, Imaizumi H, Yokoyama T, Itokawa F (2010) Diagnostic peroral video cholangioscopy is an accurate diagnostic tool for patients with bile duct lesions. Clin Gastroenterol Hepatol 8:934–938

    Article  PubMed  Google Scholar 

  27. Nimura Y (1993) Staging of biliary carcinoma: cholangiography and cholangioscopy. Endoscopy 25:76–80

    Article  PubMed  CAS  Google Scholar 

  28. Miyagawa S, Makuuchi M, Kawasaki S, Kakazu T (1995) Criteria for safe hepatic resection. Am J Surg 169:589–594

    Article  PubMed  CAS  Google Scholar 

  29. Sobin LH, Gospodarowicz M, Wittekind C (2009) International Union Against Cancer (UICC). TNM classification of malignant tumors, 7th edn. Wiley, New York

    Google Scholar 

  30. Shimada H, Endo I, Sugita M, Masunari H, Fujii Y, Tanaka K, Sekido H, Togo S (2003) Is parenchyma-preserving hepatectomy a noble option in the surgical treatment for high-risk patients with hilar bile duct cancer? Langenbecks Arch Surg 388:33–41

    PubMed  Google Scholar 

  31. Sano K, Makuuchi M, Miki K, Maema A, Sugawara Y, Imamura H, Matsunami H, Takayama T (2002) Evaluation of hepatic venous congestion: proposed indication criteria for hepatic vein reconstruction. Ann Surg 236:241–247

    Article  PubMed  Google Scholar 

  32. Bhuiya MR, Nimura Y, Kamiya J, Kondo S, Fukata S, Hayakawa N, Shionoya S (1992) Cinicopathologic studies on perineural invasion of bile duct carcinoma. Ann Surg 215:344–349

    Article  PubMed  CAS  Google Scholar 

  33. Klempnauer J, Ridder GJ, von Wasielewski R, Wermer M, Weimann A, Pichlmayr R (1997) Resectional surgery of hilar cholangiocarcinoma: a multivariate analysis of prognostic factors. J Clin Oncol 15:947–954

    PubMed  CAS  Google Scholar 

  34. Sakamoto Y, Shimada K, Nara S, Esaki M, Ojima H, Sano T, Yamamoto J, Kosuge T (2010) Surgical management of infrahilar/suprapancreatic cholangiocarcinoma: an analysis of the surgical procedures, surgical margins, and survivals of 77 patients. J Gastrointest Surg 14:335–343

    Article  PubMed  Google Scholar 

  35. Ojima H, Kanai Y, Iwasaki M, Hiraoka N, Shimada K, Sano T, Sakamoto Y, Esaki M, Kosuge T, Sakamoto M, Hirohashi S (2009) Intraductal carcinoma component as a favorable prognostic factor in biliary tract carcinoma. Cancer Sci 100:62–70

    Article  PubMed  CAS  Google Scholar 

  36. Wakai T, Shirai Y, Moroda T, Yokoyama N, Hatakeyama K (2005) Impact of ductal resection margin status on long-term survival in patients undergoing resection for extrahepatic cholangiocarcinoma. Cancer 103:1210–1216

    Article  PubMed  Google Scholar 

  37. Ebata T, Yokoyama Y, Igami T, Sugawara G, Takahashi Y, Nimura Y, Nagino M (2012) Hepatopancreatoduodenectomy for cholangiocarcinoma: a single-center review of 85 consecutive patients. Ann Surg 256:297–305

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Hepatobiliary and Pancreatic Surgery Division, Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan

    Tsuyoshi Sano, Yasuhiro Shimizu, Yoshiki Senda, Koji Komori, Seiji Ito, Tetsuya Abe, Taira Kinoshita & Yuji Nimura

  2. Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan

    Tsuyoshi Sano

Authors
  1. Tsuyoshi Sano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yasuhiro Shimizu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yoshiki Senda
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Koji Komori
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Seiji Ito
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tetsuya Abe
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Taira Kinoshita
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yuji Nimura
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tsuyoshi Sano.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sano, T., Shimizu, Y., Senda, Y. et al. Isolated caudate lobectomy with pancreatoduodenectomy for a bile duct cancer. Langenbecks Arch Surg 398, 1145–1150 (2013). https://doi.org/10.1007/s00423-013-1110-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-013-1110-5

Keywords

Search

Navigation