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Total Hilar En Bloc Resection with Left Hemihepatectomy and Caudate Lobectomy: a Novel Approach for Treatment of Left-Sided Perihilar Cholangiocarcinoma (with Video)

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Journal of Gastrointestinal Surgery

Abstract

Background

“Hilar en bloc resection” using a no-touch technique has been advocated as a standard procedure in right-sided hepatectomies for treatment of perihilar cholangiocarcinoma (PHC). In principle, it has never been reported for left-sided tumors. The aim is to describe the procedures of total hilar en bloc resection with left hemihepatectomy and caudate lobectomy (THER-LH) for advanced PHC and discuss feasibility and clinical significance of this novel technique.

Methods

A retrospective study using a prospectively maintained database was performed to identify eight patients who had received THER-LH for advanced PHC from January 2013 to December 2015. The clinicopathological features, surgical procedures, and outcomes of these patients form the basis this study.

Results

The operative time was 546 ± 158 (380–870) min, and estimated blood loss was 875 ± 690 (400–2500) ml. Time of vessel resection and reconstruction was 25.6 ± 12.3 min for the portal vein and 19.1 ± 4.9 min for the hepatic artery. Time of hilum clamping was 27.3 ± 11.9 (15–41) min. Two patients had Clavien-Dindo grade II and IVa complications of bile leakage with one developing intraabdominal abscess and bleeding. There was no perioperative mortality. Histopathologic examination revealed that all of eight patients had tubular adenocarcinoma with microscopic invasion to the resected hepatic arteries and portal veins in seven patients. Negative bile duct margins were achieved in all of them. Three patients developed recurrence and died at 11, 18, and 24 months postoperatively. The remaining patients were alive at the time of last follow-up. The median survival was 24 months with one patient achieving a disease-free survival of 50 months.

Conclusion

THER-LH is a technically demanding procedure that is safe and feasible that may have some beneficial effects on the prognosis of these patients with advanced PHC. Further studies are required to confirm the oncological superiority and survival benefits of this novel technique.

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Acknowledgements

The authors are grateful to Yu Xi for her assistance in preparing the manuscript.

Funding

The Scientific Innovation Team Project of Ningbo (Fund Number 2013B82010)

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Authors and Affiliations

  1. Department of Hepatobiliary and Pancreatic Surgery, Ningbo Medical Center Lihuili Eastern Hospital, Medical School of Ningbo University, Ningbo, 315041, China

    Cai De Lu, Jing Huang, Sheng Dong Wu, Yong Fei Hua, Jiong Zhe Fang & Sheng Ye

  2. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, 21215, USA

    Ammar A. Javed

  3. Pathological Center of Ningbo, Ningbo, 315041, China

    Chun Nian Wang

Authors
  1. Cai De Lu
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  2. Jing Huang
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  3. Sheng Dong Wu
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  4. Yong Fei Hua
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  5. Ammar A. Javed
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  6. Jiong Zhe Fang
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  7. Chun Nian Wang
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  8. Sheng Ye
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Corresponding author

Correspondence to Cai De Lu.

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Synopsis

We described our technique of total hilar en bloc resection with left hemihepatectomy and caudate lobectomy for eight patients with advanced PHC and discussed its feasibility. It is a technically demanding procedure that is safe and feasible and may have some beneficial effects on the prognosis of these patients.

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De Lu, C., Huang, J., Wu, S.D. et al. Total Hilar En Bloc Resection with Left Hemihepatectomy and Caudate Lobectomy: a Novel Approach for Treatment of Left-Sided Perihilar Cholangiocarcinoma (with Video). J Gastrointest Surg 21, 1906–1914 (2017). https://doi.org/10.1007/s11605-017-3561-4

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  • DOI: https://doi.org/10.1007/s11605-017-3561-4

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