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Surgical Anatomy of Hepatic Hilum with Special Reference of the Plate System and Extrahepatic Duct

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

When resecting hilar cholangiocarcinoma, the surgeon cannot visualize the hilar vessels through thick connective tissue known as the plate system. Little has been reported regarding the anatomical relationship between the plate system and the extrahepatic bile duct.

Methods

Twenty-five formalin-fixed cadaveric livers were dissected carefully and 7 were sectioned sagittally. The extent, composition, and distribution of the extrahepatic bile ducts within the system were investigated. The length between the confluence of the hepatic duct and the branch point of the segmental duct (level I) and the length between the branch point of the segmental duct and the segmental Glisson’s pedicle (level II) were measured.

Results

The plate system—composed of the hilar, cystic, Arantian, and umbilical regions—was easily separated from the hepatic parenchyma. Histologically, dense connective tissue with abundant capillaries, lymphatic vessels, and neural fibers were noted. Level I of B1pcp and B4a measured 13.0 and 14.7 mm, respectively. Level II measured 8.6 and 17.3 mm, respectively.

Conclusions

The bile ducts in the plate system correspond to the extrahepatic bile ducts and their lengths are variable for every segment. Knowing the lengths of the resectable extrahepatic bile ducts is useful for deciding which segment should be resected according to the cancerous invasion.

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Abbreviations

CL:

caudate lobe

H.E.:

hematoxylin eosin

SP:

Spiegel lobe

PCP:

paracaval portion

IVC:

inferior vena cava

CP:

caudate process

PP:

posterior portion of the right portal vein

UP:

umbilical portion of the left portal vein

LHD:

left hepatic duct

RHV:

right hepatic vein

MHV:

middle hepatic vein

LHV:

left hepatic vein

FV:

fissure vein

GB:

gallbladder

CBD:

common bile duct

PV:

portal vein

GX:

Glisson’s of segment X

BX:

bile duct of segment X

AX:

artery of segment X

pcp:

paracaval portion

PHA:

proper hepatic artery

cp:

caudate process

sp:

Spiegel lobe

RPV:

right portal vein

CA:

cystic artery

CD:

cystic duct

AD:

Arantian duct

ne:

neural fibers

ly:

lymphatic vessels

c:

small capillaries

b:

small bile ducts

References

  1. Bismuth H, Nakache R, Diamond T. Management strategies in resection for hilar cholangiocarcinoma. Ann Surg 1992;215:31–38.

    Article  PubMed  CAS  Google Scholar 

  2. Neuhaus P, Jonas S, Bechstein WO, Lohmann R, Radke C, Kling N, et al. Extended resections for hilar cholangiocarcinoma. Ann Surg 1999;230:808–819.

    Article  PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  4. Su CH, Tsay SH, Wu CC, Shyr YM, King KL, Lee CH, et al. Factors influencing postoperative morbidity, mortality, and survival after resection for hilar cholangiocarcinoma. Ann Surg 1996;223:384–394.

    Article  PubMed  CAS  Google Scholar 

  5. Pichimayr R, Weinmann A, Klempnauer J, Oldhafer KJ, Maschek H, Tusch G, et al. Surgical treatment in proximal bile duct cancer. Ann Surg 1996;224:628–638.

    Article  Google Scholar 

  6. Boerma EJ, Bronkhorst FB, van Haelst UJGM, de Boer HHM. An anatomic invastigation of radical resection of tumor in the hepatic duct confluence. Surg Gynecol Obstet 1985;161:223–228.

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  8. Bartlett D, Fong Y, Blumgart LH. Complete resection of the caudate lobe of the liver: technique and results. Br J Surg 1996;83:1076–1081.

    Article  PubMed  CAS  Google Scholar 

  9. Kumon M. Anatomy of the caudate lobe with special reference to portal vein and bile duct. Acta Hepatol Jpn 1985;26:1193–1199.

    Google Scholar 

  10. Kawarada Y, Das BC, Onishi H, Taoka H, Gadzijev EM, Ravnik D, et al. Surgical anatomy of the bile duct branches of the medial segment (B4) of the liver in relation to hilar carcinoma. J Hepatobiliary Pancreat Surg 2000;7:480–485.

    Article  PubMed  CAS  Google Scholar 

  11. Couinaud C. Le Foie: Etudes Anatomiques et Chiruricales. Paris: Masson, 1957.

    Google Scholar 

  12. Couinaud C. Surgical Anatomy of the Liver Revisited. Paris: C. Couinaud, 1989.

    Google Scholar 

  13. Kogure K, Kuwano H, Fujimaki N, Makuuti M. Relation among portal segmentation, proper hepatic vein, and external notch of the caudate lobe in the human liver. Ann Surg 2000;231:223–228.

    Article  PubMed  CAS  Google Scholar 

  14. Kumon M. Anatomy of the caudate lobe with special reference to portal vein and bile duct. Acta Hepatol Jpn 1985;26:1193–1199.

    Google Scholar 

  15. Couinaud C. The paracaval segments of the liver. J Hepatobiliary Pancreat Surg 1994;2:145–151.

    Article  Google Scholar 

  16. Mizumoto R, Suzuki H. Surgical anatomy of the hepatic hilium with special reference to the caudate lobe. World J Surg 1988;12:2–10.

    Article  PubMed  CAS  Google Scholar 

  17. Togo S, Shizawa R, Kanemura E, Tanaka K, Masunari H, Endo I, et al. Usefulness of 3-dimentional computed tomography for caudate lobectomy by transhepatic anterior approach. Hepatogastroenterology 2002;49:461–466.

    PubMed  Google Scholar 

  18. Shimada H, Endo I, Fujii Y, Kunihiro O, Tanaka K, Misuta K, et al. Procedure of extended hilar bile duct resection and its application for hilar cholangiocarcinoma. Hepatogastroenterology 2002;49:300–305.

    PubMed  Google Scholar 

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Correspondence to Hideki Masunari.

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Masunari, H., Shimada, H., Endo, I. et al. Surgical Anatomy of Hepatic Hilum with Special Reference of the Plate System and Extrahepatic Duct. J Gastrointest Surg 12, 1047–1053 (2008). https://doi.org/10.1007/s11605-007-0358-x

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  • DOI: https://doi.org/10.1007/s11605-007-0358-x

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