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Right hepatectomy with resection of caudate lobe and extrahepatic bile duct for hilar cholangiocarcinoma

  • Itaru EndoEmail author
  • Ryusei Matsuyama
  • Koichi Taniguchi
  • Mitsutaka Sugita
  • Kazuhisa Takeda
  • Kuniya Tanaka
  • Hiroshi Shimada
Topics Highly advanced surgery in the hepatobiliary and pancreatic field (Biliary Section)

Abstract

En-bloc liver resection with caudate lobectomy (segmentectomy 1) is the standard procedure for hilar cholangiocarcinoma. Although its surgical mortality has been reduced below 5%, it is still a potentially hazardous operation. Complete tumor resection with negative surgical margins and safe reconstruction of bilio-enteric continuity are two principles of the surgical treatment of hilar cholangiocarcinoma. Surgeons must pay attention to the variation of the hilar structures including portal veins, hepatic arteries, and bile ducts. Three-dimensional imaging is beneficial not only for understanding anatomical variations but also for preoperative simulations. Since the U-point can be identified by both preoperative imaging and intraoperative inspection, it can be used as the landmark for the hepatectomy and the dissection point of the hilar plate. The hanging maneuver might be useful for both hepatic parenchymal dissection and bile duct dissection just right of the U-point. For safe biliary reconstruction, stay sutures in the anterior wall and transanastomotic stents may be helpful.

Keywords

Hilar cholangiocarcinoma 3DCT Caudate lobe Right hemihepatectomy Trisectionectomy Hanging maneuver 

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

Supplementary material 1 (MPG 13397 kb)

Supplementary material 2 (MPG 14763 kb)

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Copyright information

© Japanese Society of Hepato-Biliary-Pancreatic Surgery and Springer 2011

Authors and Affiliations

  • Itaru Endo
    • 1
    Email author
  • Ryusei Matsuyama
    • 1
  • Koichi Taniguchi
    • 1
  • Mitsutaka Sugita
    • 1
  • Kazuhisa Takeda
    • 1
  • Kuniya Tanaka
    • 1
  • Hiroshi Shimada
    • 1
  1. 1.Department of Gastroenterological Surgery, Graduate School of MedicineYokohama City UniversityYokohamaJapan

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