Abstract
Background/purpose
There have been few reports on the diagnostic ability of multidetector-row computed tomography (MDCT) to assess invasion of the hepatic artery. The aim of this study was to assess the diagnostic ability of MDCT for right hepatic artery (RHA) invasion.
Methods
From August 2006 to October 2010, 103 consecutive patients with left-sided predominance perihilar cholangiocarcinoma underwent left-sided hepatectomy; all patients received MDCT as a preoperative workup. Three-dimensional volume-rendered and multiplanar reformation (MPR) images were retrospectively examined for evidence of RHA invasion, and the agreement between intraoperative macroscopic and histologic findings was assessed.
Results
No macroscopic evidence of RHA invasion was found in any of the 50 patients presenting visible low-density planes on MPR images between the RHA and adjacent tumor. Of the remaining 53 patients without visible low-density planes, 38 patients presented macroscopic evidence of RHA invasion and underwent combined RHA resection; the other 15 patients did not exhibit RHA invasion. The RHA contact length, as measured on MDCT images by curved planar reformations, was significantly longer in the former 38 patients than in the latter 15 patients (24.3 ± 16.9 vs. 8.6 ± 3.0 mm, respectively, P = 0.001). Histologic cancer infiltration of the resected RHA was found in 18 (47.4%) of the 38 patients who underwent RHA resection. Diagnosis of macroscopic RHA invasion based on the presence or absence of a low-density plane had an accuracy of 85.4%.
Conclusions
We conclude that MDCT is useful for assessing RHA invasion by perihilar cholangiocarcinoma.
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References
Ebata T, Kamiya J, Nishio H, Nagasaka T, Nimura Y, Nagino M. The concept of perihilar cholangiocarcinoma is valid. Br J Surg. 2009;96:926–34.
Nakeeb A, Pitt HA, Sohn TA, Coleman J, Abrams RA, Piantadosi S, et al. Cholangiocarcinoma. A spectrum of intrahepatic, perihilar, and distal tumors. Ann Surg. 1996;224:463–73 (discussion 73–5).
Neuhaus P, Jonas S, Bechstein WO, Lohmann R, Radke C, Kling N, et al. Extended resections for hilar cholangiocarcinoma. Ann Surg. 1999;230:808–18 (discussion 19).
Jarnagin WR, Fong Y, DeMatteo RP, Gonen M, Burke EC, Bodniewicz J, et al. Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg. 2001;234:507–19.
Capussotti L, Muratore A, Polastri R, Ferrero A, Massucco P. Liver resection for hilar cholangiocarcinoma: in hospital mortality and long-term survival. J Am Coll Surg. 2002;195:641–7.
Seyama Y, Kubota K, Sano K, Noie T, Takayama T, Kosuge T, et al. Long-term outcome of extended hemihepatectomy for hilar bile duct cancer with no mortality and high survival rate. Ann Surg. 2003;238:73–83.
Kawasaki S, Imamura H, Kobayashi A, Noike T, Miwa S, Miyagawa S. 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. 2003;238:84–92.
Kondo S, Hirano S, Ambo Y, Tanaka E, Okushiba S, Morikawa T, et al. Forty consecutive resections of hilar cholangiocarcinoma with no postoperative mortality and no positive ductal margins: results of a prospective study. Ann Surg. 2004;240:95–101.
Hemming AW, Reed AI, Fujita S, Foley DP, Howard RJ. Surgical management of hilar cholangiocarcinoma. Ann Surg. 2005;241:693–702.
Sano T, Shimada K, Sakamoto Y, Yamamoto J, Yamasaki S, Kosuge T. One hundred two consecutive hepatobiliary resections for perihilar cholangiocarcinoma with zero mortality. Ann Surg. 2006;244:240–7.
Ikeyama T, Nagino M, Oda K, Ebata T, Nishio H, Nimura Y. Surgical approach to bismuth Type I and II hilar cholangiocarcinomas: audit of 54 consecutive cases. Ann Surg. 2007;246:1052–7.
Shimizu H, Kimura F, Yoshidome H, Ohtsuka M, Kato A, Yoshitomi H, et al. Aggressive surgical resection for hilar cholangiocarcinoma of the left-side predominance: radicality and safety of left-sided hepatectomy. Ann Surg. 2010;251:281–6.
Igami T, Nishio H, Ebata T, Yokoyama Y, Sugawara G, Nimura Y, et al. Surgical treatment of hilar cholangiocarcinoma in the “new era”: the Nagoya University experience. J Hepatobiliary Pancreat Surg. 2010;17:449–54.
Lee SG, Song GW, Hwang S, Ha TY, Moon DB, Jung DH, et al. Surgical treatment of hilar cholangiocarcinoma in new era; the Asan experience. J Hepatobiliary Pancreat Sci. 2010;17:476–89.
Gerhards MF, Gulik TM, de Wit LT, Obertop H, Gouma DJ. Evaluation of morbidity and mortality after resection for hilar cholangiocarcinoma—a single center experience. Surgery. 2000;127:395–404.
Ota T, Araida T, Yamamoto M, Takasaki K. Operative outcome and problems of right hepatic lobectomy with pancreatoduodenectomy for advanced carcinoma of the biliary tract. J Hepatobiliary Pancreat Surg. 2007;14:155–8.
Miyazaki M, Kato A, Ito H, Kimura F, Shimizu H, Ohtsuka M, et al. Combined vascular resection in operative resection for hilar cholangiocarcinoma: does it work or not? Surgery. 2007;141:581–8.
Sakamoto Y, Sano T, Shimada K, Kosuge T, Kimata Y, Sakuraba M, et al. Clinical significance of reconstruction of the right hepatic artery for biliary malignancy. Langenbeck’s Arch Surg. 2006;391:203–8.
Shimada H, Endo I, Sugita M, Masunari H, Fujii Y, Tanaka K, et al. Hepatic resection combined with portal vein or hepatic artery reconstruction for advanced carcinoma of the hilar bile duct and gallbladder. World J Surg. 2003;27:1137–42.
Nagino M, Nimura Y, Nishio H, Ebata T, Igami T, Matsushita M, et al. Hepatectomy with simultaneous resection of the portal vein and hepatic artery for advanced perihilar cholangiocarcinoma: an audit of 50 consecutive cases. Ann Surg. 2010;252:115–23.
Sugiura T, Nishio H, Nagino M, Senda Y, Ebata T, Yokoyama Y, et al. Value of multidetector-row computed tomography in diagnosis of portal vein invasion by perihilar cholangiocarcinoma. World J Surg. 2008;32:1478–84.
Chen HW, Pan AZ, Zhen ZJ, Su SY, Wang JH, Yu SCH, et al. Preoperative evaluation of resectability of Klatskin tumor with 16-MDCT angiography and cholangiography. AJR Am J Roentgenol. 2006;186:1580–6.
Aloia TA, Charnsangavej C, Faria S, Ribero D, Abdalla EK, Vauthey JN, et al. High-resolution computed tomography accurately predicts resectability in hilar cholangiocarcinoma. Am J Surg. 2007;193:702–6.
Endo I, Shimada H, Sugita M, Fujii Y, Morioka D, Takeda K, et al. Role of three-dimensional imaging in operative planning for hilar cholangiocarcinoma. Surgery. 2007;142:666–75.
Unno M, Okumoto T, Katayose Y, Rikiyama T, Sato A, Motoi F, et al. Preoperative assessment of hilar cholangiocarcinoma by multidetector row computed tomography. J Hepatobiliary Pancreat Surg. 2007;14:434–40.
Chen HW, Lai EC, Pan AZ, Chen T, Liao S, Lau WY. Preoperative assessment and staging of hilar cholangiocarcinoma with 16-multidetector computed tomography and angiography. Hepatogastroenterology. 2009;56:578–83.
International Union Against Cancer (UICC). TNM classification of malignant tumors. 7th ed. New York: Wiley-Liss; 2009.
Park HS, Lee JM, Choi JY, Lee MW, Kim HJ, Han JK, et al. Preoperative evaluation of bile duct cancer: MRI combined with MR cholangiopancreatography versus MDCT with direct cholangiography. AJR Am J Roentgenol. 2008;190:396–405.
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Fukami, Y., Ebata, T., Yokoyama, Y. et al. Diagnostic ability of MDCT to assess right hepatic artery invasion by perihilar cholangiocarcinoma with left-sided predominance. J Hepatobiliary Pancreat Sci 19, 179–186 (2012). https://doi.org/10.1007/s00534-011-0413-6
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DOI: https://doi.org/10.1007/s00534-011-0413-6