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World Journal of Surgery

, Volume 43, Issue 3, pp 894–901 | Cite as

Left Hepatectomy with Combined Resection and Reconstruction of Right Hepatic Artery for Bismuth Type I and II Perihilar Cholangiocarcinoma

  • Teiichi SugiuraEmail author
  • Yukiyasu Okamura
  • Takaaki Ito
  • Yusuke Yamamoto
  • Ryo Ashida
  • Katsuhisa Ohgi
  • Masahiro Nakagawa
  • Katsuhiko Uesaka
Original Scientific Report (including Papers Presented at Surgical Conferences)
  • 116 Downloads

Abstract

Background

Right hepatectomy with caudate lobectomy (RHx) is considered an appropriate procedure for Bismuth type I/II perihilar cholangiocarcinoma in terms of its anatomical and oncological aspect. However, validity of left hepatectomy with caudate lobectomy (LHx) concomitant with arterial resection and reconstruction (AR) is not fully evaluated.

Methods

The patients who underwent surgical resection for Bismuth type I/II perihilar cholangiocarcinoma between 2002 and 2013 were studied. The standard procedure for Bismuth type I/II cholangiocarcinoma in the institute was RHx, while in patients who had insufficient functional reserve of the left liver, LHx was selected, irrespective of the necessity of AR. The clinicopathologic and perioperative outcomes after LHx + AR were compared with those after RHx.

Results

The surgical procedures comprised LHx + AR in 12 and RHx in 24. The left liver volume and left liver functional reserve were significantly lower with LHx + AR than with RHx (left liver volume: 28.0 vs. 33.7%, p = 0.026; estimated indocyanine green clearance of the left liver: 0.036 vs. 0.046, p < 0.001). The rate of surgical morbidity was almost identical between the two procedures. No arterial reconstruction-related complications occurred. The overall 3- and 5-year survival rates and median survival time were 66.7%, 41.7% and 44 months for LHx + AR and 70.8%, 49.0% and 57 months for RHx (p = 0.640).

Conclusion

LHx + AR for Bismuth type I/II perihilar cholangiocarcinoma is considered to be a valid alternative to RHx in patients with an insufficient left liver functional reserve.

Notes

Compliance with ethical standards

Conflict of interest

The authors declare no financial or any other type of support.

References

  1. 1.
    Klatskin G (1965) Adenocarcinoma of the hepatic duct at its bifurcation within the porta hepatis. An unusual tumor with distinctive clinical and pathological features. Am J Med 38:241–256CrossRefGoogle Scholar
  2. 2.
    Nagino M, Ebata T, Yokoyama Y et al (2013) Evolution of surgical treatment for perihilar cholangiocarcinoma: a single-center 34-year review of 574 consecutive resections. Ann Surg 258:129–140CrossRefGoogle Scholar
  3. 3.
    Ebata T, Yokoyama Y, Igami T et al (2012) Hepatopancreatoduodenectomy for cholangiocarcinoma: a single-center review of 85 consecutive patients. Ann Surg 256:297–305CrossRefGoogle Scholar
  4. 4.
    Ebata T, Nagino M, Kamiya J et al (2003) Hepatectomy with portal vein resection for hilar cholangiocarcinoma: audit of 52 consecutive cases. Ann Surg 238:720–727CrossRefGoogle Scholar
  5. 5.
    Miyazaki M, Kato A, Ito H et al (2007) Combined vascular resection in operative resection for hilar cholangiocarcinoma: does it work or not? Surgery 141:581–588CrossRefGoogle Scholar
  6. 6.
    Ebata T, Ito T, Yokoyama Y et al (2014) Surgical technique of hepatectomy combined with simultaneous resection of hepatic artery and portal vein for perihilar cholangiocarcinoma (with video). J Hepato-Biliary-Pancreat Sci 21:E57–E61CrossRefGoogle Scholar
  7. 7.
    Nagino M, Nimura Y, Nishio H et al (2010) Hepatectomy with simultaneous resection of the portal vein and hepatic artery for advanced perihilar cholangiocarcinoma: an audit of 50 consecutive cases. Ann Surg 252:115–123CrossRefGoogle Scholar
  8. 8.
    Bismuth H, Nakache R, Diamond T (1992) Management strategies in resection for hilar cholangiocarcinoma. Ann Surg 215:31–38CrossRefGoogle Scholar
  9. 9.
    Neuhaus P, Jonas S, Bechstein WO et al (1999) Extended resections for hilar cholangiocarcinoma. Ann Surg 230:808–818 (discussion 819) CrossRefGoogle Scholar
  10. 10.
    Jarnagin WR, Fong Y, DeMatteo RP et al (2001) Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg 234:507–517 (discussion 517-509) CrossRefGoogle Scholar
  11. 11.
    Capussotti L, Muratore A, Polastri R et al (2002) Liver resection for hilar cholangiocarcinoma: in-hospital mortality and longterm survival. J Am Coll Surg 195:641–647CrossRefGoogle Scholar
  12. 12.
    Kondo S, Hirano S, Ambo Y et al (2004) Forty consecutive resections of hilar cholangiocarcinoma with no postoperative mortality and no positive ductal margins: results of a prospective study. Ann Surg 240:95–101CrossRefGoogle Scholar
  13. 13.
    Lim JH, Choi GH, Choi SH et al (2013) Liver resection for Bismuth type I and type II hilar cholangiocarcinoma. World J Surg 37:829–837.  https://doi.org/10.1007/s00268-013-1909-9 CrossRefGoogle Scholar
  14. 14.
    Xiong J, Nunes QM, Huang W et al (2015) Major hepatectomy in Bismuth types I and II hilar cholangiocarcinoma. J Surg Res 194:194–201CrossRefGoogle Scholar
  15. 15.
    Ikeyama T, Nagino M, Oda K et al (2007) Surgical approach to Bismuth type I and II hilar cholangiocarcinomas: audit of 54 consecutive cases. Ann Surg. 246:1052–1057CrossRefGoogle Scholar
  16. 16.
    Seyama Y, Kubota K, Sano K et al (2003) Long-term outcome of extended hemihepatectomy for hilar bile duct cancer with no mortality and high survival rate. Ann Surg 238:73–83Google Scholar
  17. 17.
    Kawasaki S, Imamura H, Kobayashi A et al (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 238:84–92Google Scholar
  18. 18.
    Jonas S, Benckert C, Thelen A et al (2008) Radical surgery for hilar cholangiocarcinoma. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol 34:263–271Google Scholar
  19. 19.
    Farges O, Belghiti J, Kianmanesh R et al (2003) Portal vein embolization before right hepatectomy: prospective clinical trial. Ann Surg 237:208–217Google Scholar
  20. 20.
    Abdalla EK, Denys A, Chevalier P et al (2004) Total and segmental liver volume variations: implications for liver surgery. Surgery 135:404–410CrossRefGoogle Scholar
  21. 21.
    Tongyoo A, Pomfret EA, Pomposelli JJ (2012) Accurate estimation of living donor right hemi-liver volume from portal vein diameter measurement and standard liver volume calculation. Am J Transplant Off J Am Soc Transplant Am Soc Transplant Surg 12:1229–1239CrossRefGoogle Scholar
  22. 22.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefGoogle Scholar
  23. 23.
    Rahbari NN, Garden OJ, Padbury R et al (2011) Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery 149:713–724CrossRefGoogle Scholar
  24. 24.
    Sugiura T, Nishio H, Nagino M et al (2008) Value of multidetector-row computed tomography in diagnosis of portal vein invasion by perihilar cholangiocarcinoma. World J Surg 32:1478–1484.  https://doi.org/10.1007/s00268-008-9547-3 CrossRefGoogle Scholar
  25. 25.
    Senda Y, Nishio H, Oda K et al (2009) Value of multidetector row CT in the assessment of longitudinal extension of cholangiocarcinoma: correlation between MDCT and microscopic findings. World J Surg 33:1459–1467.  https://doi.org/10.1007/s00268-009-0025-3 CrossRefGoogle Scholar
  26. 26.
    Fukami Y, Ebata T, Yokoyama Y et al (2012) Diagnostic ability of MDCT to assess right hepatic artery invasion by perihilar cholangiocarcinoma with left-sided predominance. J Hepato-Biliary-Pancreat Sci 19:179–186CrossRefGoogle Scholar
  27. 27.
    Nagino M, Kamiya J, Nishio H et al (2006) Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer: surgical outcome and long-term follow-up. Ann Surg 243:364–372CrossRefGoogle Scholar
  28. 28.
    Yokoyama Y, Nishio H, Ebata T et al (2010) Value of indocyanine green clearance of the future liver remnant in predicting outcome after resection for biliary cancer. Br J Surg 97:1260–1268CrossRefGoogle Scholar
  29. 29.
    Sobin L, Gosporarowicz M, Wittekind C (2009) TNM classification of malignant tumors, 7th edn. Wiley-Blackwell, New YorkGoogle Scholar
  30. 30.
    Neuhaus P, Jonas S, Settmacher U et al (2003) Surgical management of proximal bile duct cancer: extended right lobe resection increases resectability and radicality. Langenbeck’s Arch Surg/Deutsche Gesellschaft fur Chirurgie 388:194–200CrossRefGoogle Scholar
  31. 31.
    Noji T, Tsuchikawa T, Okamura K et al (2016) Concomitant hepatic artery resection for advanced perihilar cholangiocarcinoma: a case-control study with propensity score matching. J Hepato-Biliary-Pancreat Sci 23:442–448CrossRefGoogle Scholar
  32. 32.
    Matsuyama R, Mori R, Ota Y et al (2016) Significance of vascular resection and reconstruction in surgery for hilar cholangiocarcinoma: with special reference to hepatic arterial resection and reconstruction. Ann Surg Oncol 23:475–484CrossRefGoogle Scholar
  33. 33.
    Peng C, Li C, Wen T et al (2016) Left hepatectomy combined with hepatic artery resection for hilar cholangiocarcinoma: a retrospective cohort study. Int J Surg 32:167–173CrossRefGoogle Scholar
  34. 34.
    Yoshioka Y, Ebata T, Yokoyama Y et al (2011) “Supraportal” right posterior hepatic artery: an anatomic trap in hepatobiliary and transplant surgery. World J Surg 35:1340–1344.  https://doi.org/10.1007/s00268-011-1075-x CrossRefGoogle Scholar
  35. 35.
    Hirose T, Igami T, Ebata T et al (2015) Surgical and radiological studies on the length of the hepatic ducts. World J Surg 39:2983–2989.  https://doi.org/10.1007/s00268-015-3201-7 CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Teiichi Sugiura
    • 1
    Email author
  • Yukiyasu Okamura
    • 1
  • Takaaki Ito
    • 1
  • Yusuke Yamamoto
    • 1
  • Ryo Ashida
    • 1
  • Katsuhisa Ohgi
    • 1
  • Masahiro Nakagawa
    • 2
  • Katsuhiko Uesaka
    • 1
  1. 1.Division of Hepato-Biliary-Pancreatic SurgeryShizuoka Cancer CenterSunto-NagaizumiJapan
  2. 2.Division of Plastic SurgeryShizuoka Cancer CenterShizuokaJapan

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