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Clinical Implications of Biliary Confluence Pattern for Bismuth-Corlette Type IV Hilar Cholangiocarcinoma Applied to Hemihepatectomy

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Since biliary variations are commonly seen, our aims are to clarify these insidious variations and discuss their surgicopathologic implications for Bismuth-Corlette (BC) type IV hilar cholangiocarcinoma (HC) applied to hemihepatectomy.

Methods

Three-dimensional images of patients with distal bile duct obstruction (n = 97) and advanced HC (n = 79) were reconstructed and analyzed retrospectively. Normal biliary confluence pattern was defined as the peripheral segment IV duct (B4) joining the common trunk of segment II (B2) and segment III (B3) ducts to form the left hepatic duct (LHD) that then joined the right hepatic duct (RHD). The lengths from left and right secondary biliary ramifications to the right side of the umbilical portion of the left portal vein (Rl-L) and the cranio-ventral side of the right portal vein (Rr-R) were measured, respectively, and compared with the resectable bile duct length in HCs. Surgicopathologic findings were compared between different BC types.

Results

The resectable bile duct length in right hemihepatectomy for eradication of type IV tumors was significantly longer than the Rl-L length in normal biliary configuration (17.4 ± 1.8 and 10.3 ± 3.4 mm, respectively, p < 0.001), and type III variation (B2 joining the common trunk of B3 and B4) was the predominant configuration (53.8%). The resectable length in left hemihepatectomy for eradication of type IV tumors was comparable with the Rr-R length in RHD absent cases (15.2 ± 2.5 and 16.4 ± 2.6 mm, respectively, p = 0.177) but significantly longer than that in normal configuration (p < 0.001). The estimated length was 8.5 ± 2.0 mm in unresectable cases. There was no significant difference between type III and IV tumors, except for the rate of nodal metastasis (29.7 and 76.0%, respectively, p < 0.001).

Conclusion

Hemihepatectomy might be selected for curative-intent resection of BC type IV tumors considering the advantageous biliary variations, whereas anatomical trisegmentectomy is recommended for the resectable bile duct length less than 10 mm. Biliary variations might result in excessive classification of BC type IV but require validation on further study.

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Acknowledgments

This study is supported by the China Postdoctoral Science Foundation (2015M581837).

Authors’ Contribution

Gu-wei Ji drafted the paper and Fei-peng Zhu was responsible for radiological evaluation. Ke Wang, Chen-yu Jiao, and Zi-cheng Shao conducted the data analysis. The corresponding author, Xiang-cheng Li, designed the study.

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Authors and Affiliations

  1. Key Laboratory on Living Donor Liver Transplantation, Ministry of Health, Department of Liver Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, People’s Republic of China

    Gu-wei Ji, Ke Wang, Chen-yu Jiao, Zi-cheng Shao & Xiang-cheng Li

  2. Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People’s Republic of China

    Fei-peng Zhu

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  1. Gu-wei Ji
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  2. Fei-peng Zhu
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Correspondence to Xiang-cheng Li.

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The authors declare that they have no competing interests.

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Gu-wei Ji and Fei-peng Zhu contributed equally to this work.

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Ji, Gw., Zhu, Fp., Wang, K. et al. Clinical Implications of Biliary Confluence Pattern for Bismuth-Corlette Type IV Hilar Cholangiocarcinoma Applied to Hemihepatectomy. J Gastrointest Surg 21, 666–675 (2017). https://doi.org/10.1007/s11605-017-3377-2

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  • DOI: https://doi.org/10.1007/s11605-017-3377-2

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