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A New Technique of Biliary Reconstruction After “High Hilar Resection” of Hilar Cholangiocarcinoma with Tumor Extension to Secondary and Tertiary Biliary Radicals

  • Hepatic and Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Radical operation for hilar cholangiocellular carcinoma, including extended hepatic resection, seems to improve prognosis by increasing the surgical curability rate. Nevertheless, high postoperative morbidity and mortality have been reported in patients with obstructive jaundice. We describe the technique of “high hilar resection” and a modification of bilioenteric anastomosis for drainage of the multiple secondary or tertiary biliary radicals.

Methods

Ten patients with advanced hilar cholangiocellular carcinoma underwent a high hilar resection with complete parenchymal preservation, and the biliary drainage was reconstructed by a sheath-to-enteric hepaticojejunostomy. Because of the technical difficulty caused by anastomosis line in the range of the biliary sheath, a modification was performed by dividing the biliary apertures of segments 5 and 4b.

Results

A high hilar resection was successfully performed, and all patients were discharged from the hospital in good condition. No patient died postoperatively. The proximal resection margin was tumor-free in all patients. One patient died after 29 months of peritoneal carcinomatosis. None of the patients developed local recurrence around the hepaticojejunostomy. The remaining nine patients are alive after a mean follow-up of 28.8 months after surgery without any signs of recurrence.

Conclusion

In highly selected patients with advanced hilar cholangiocellular carcinoma, a high hilar resection is technically safe and oncologically justifiable. In combination with our new technique of sheath-to-enteric anastomosis, the patients considerably benefit from the preservation of liver parenchyma with low postoperative morbidity and very short in-hospital stay.

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Authors and Affiliations

  1. Organ Transplantation and Research Center, Ege University School of Medicine, Izmir, Turkey

    Unal Aydin MD, Suleyman Yedibela MD, Pinar Yazici MD, Murat Zeytunlu MD, Murat Kilic MD & Ahmet Coker MD

  2. Department of General Surgery, Medical Faculty, Ataturk University, Erzurum, Turkey

    Bulent Aydinli MD

Authors
  1. Unal Aydin MD
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  2. Suleyman Yedibela MD
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  3. Pinar Yazici MD
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  4. Bulent Aydinli MD
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  5. Murat Zeytunlu MD
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  6. Murat Kilic MD
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  7. Ahmet Coker MD
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Correspondence to Unal Aydin MD.

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Aydin, U., Yedibela, S., Yazici, P. et al. A New Technique of Biliary Reconstruction After “High Hilar Resection” of Hilar Cholangiocarcinoma with Tumor Extension to Secondary and Tertiary Biliary Radicals. Ann Surg Oncol 15, 1871–1879 (2008). https://doi.org/10.1245/s10434-008-9926-x

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  • DOI: https://doi.org/10.1245/s10434-008-9926-x

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