Langenbeck's Archives of Surgery

, Volume 386, Issue 5, pp 364–368

Left hemihepatectomy with microsurgical reconstruction of the right-sided hepatic vasculature

A strategy for preserving hepatic function in patients with proximal bile duct cancer
  • Naoki Yamanaka
  • Chiaki Yasui
  • Junichi Yamanaka
  • Tatsuya Ando
  • Nobukazu Kuroda
  • Shigeto Maeda
  • Takaaki Ito
  • Eizo Okamoto
Original Article

DOI: 10.1007/s004230100225

Cite this article as:
Yamanaka, N., Yasui, C., Yamanaka, J. et al. Langenbeck's Arch Surg (2001) 386: 364. doi:10.1007/s004230100225
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Abstract.

Background: Right hemihepatectomy (RH) for proximal bile duct canceroccasionally results in liver failure. We report the feasibility of left hemihepatectomy (LH) with vascular reconstruction (VR) of the right-sided hilar vessels to preserve hepatic reserve. Methods: Among 110 patients with proximal bile duct cancer (PBC) treated between January 1980 and December 1998, 11 patients underwent LH with VR of eight portal veins and nine hepatic arteries, and 14 underwent RH with VR of four portal veins and one hepatic artery. Microsurgical techniques were used in 80% (8/10) of the hepatic arterial reconstructions. Results: Although operation time was significantly longer in the LH group, hospital mortality, blood loss and incidence of histologically cancer positive margin at the bilioenteric anastomotic site were similar in the two groups. Peak serum liver enzyme concentration was significantly higher in the LH group with longer inflow occlusion time, whereas peak serum total bilirubin concentration was significantly higher in the RH group, which had smaller liver remnant. No liver abscess occurred in any patients who underwent microvascular reconstructions. The cumulative survival of the LH group was worse than that of the RH group, in which the proportion of vascular invasion was lower, but not significantly. Conclusion: LH with right-sided microvascular reconstruction is technically possible and a feasible option when RH is likely to result in postoperative liver failure.

Proximal bile duct cancer Vascular reconstruction Microsurgery Left hemihepatectomy Right hemihepatectomy 

Copyright information

© Springer-Verlag 2001

Authors and Affiliations

  • Naoki Yamanaka
    • 1
  • Chiaki Yasui
    • 2
  • Junichi Yamanaka
    • 2
  • Tatsuya Ando
    • 2
  • Nobukazu Kuroda
    • 2
  • Shigeto Maeda
    • 2
  • Takaaki Ito
    • 3
  • Eizo Okamoto
    • 2
  1. 1.Meiwa General Hospital, 4-31, Agenaruo-Cho, Nishinomiya, Japan 663-8186
  2. 2.First Department of Surgery, Hyogo College of Medicine 1-1, Mukogawa-cho, Nishinomiya, Japan 663-8501
  3. 3.Department of Dermatology, Hyogo College of Medicine 1-1, Mukogawa-cho, Nishinomiya, Japan 663-8501

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