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Hepatic segmentectomy with caudate lobe resection for bile duct carcinoma of the hepatic hilus

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Abstract

From 1979 through 1989, surgical resection was performed in 55 of 66 patients with carcinoma of the hepatic hilus after improving jaundice by percutaneous transhepatic biliary drainage (PTBD). Selective cholangiography through PTBD was done to define precisely the anatomical location—extent of the obstructing lesion in each segmental hepatic duct. Percutaneous transhepatic cholangioscopy was performed through the sinus tract of PTBD after replacing the drainage catheter with a 15 French catheter for superselective cholangiography and biopsy to make the definitive diagnosis of the histological extent of the tumor and any variation of each segmentai hepatic duct that joins the hepatic hilus.

In 46 (69.7%) of 66 patients, curative resection was possible. Forty-five of these underwent various types of hepatic segmentectomy with caudate lobectomy for a morbidity rate of 41.3% and an operative mortality rate of 6.4%. Fourteen (31.1%) advanced cases underwent combined resection of the portal vein together with hepatectomy. Microscopic tumor involvement in the caudate branches was confirmed in 44 of 45 patients who underwent caudate lobe resection. The 3-year survival rate for all 43 patients surviving the curative excision was 55.1% and the 5-year survival rate was 40.5%. All 11 patients who had an unresectable advanced tumor died within 9 months.

Curative resection should be designed according to the preoperative findings of the extent of cancer in each segmental duct, and caudate lobe resection should be performed together with the smallest necessary hepatic segmentectomy possible.

Résumé

De 1979 à 1989 la résection chirurgicale a été effectuée chez 55 des 66 patients ayant un cancer du hile hépatique après diminué l'ictère par drainage biliaire transhépatique percutané (DBTP). La cholangiographie sélective par DBTP a défini avec exactitude le site anatomique—l'étendue de l'obstruction dans chaque canal hépatique segmentaire intéressé. La cholangioscopie transhépatique percutanée a été pratiquée par le trajet du drainage après avoir remplacé le cathéter de drainage par un cathéter F15. On a réalisé ainsi une cholangiographie hypersélective et effectué des biopsies pour établir le diagnostic définitif, préciser l'étendue histologique de la tumeur et décéler toutes les variations anatomiques des canaux hépatiques segmentaires se jettant dans le hile.

Pour 46 (69.7%) patients sur 66, la résection curative a été possible. Parmi eux, 45 ont eu différents types de segmentectomies hépatiques intéressant le lobe caudé avec un taux de morbidité de 41.3% et un taux de mortalité opératoire de 6.4%. Quatorze (31.1%) patients avec des lésions avancées ont eu à la fois résection de la veine porte et hépatectomie. L'envahissement histologique des branches caudales a été confirmé chez 44 des 45 patients qui ont eu une résection du lobe caudé. Le taux de survie à 3 ans pour les 43 patients survivants à l'excision curative était de 55.1% et le taux de survie à 5 ans était de 40.5%. Les 11 patients qui avaient une tumeur avancée non résécable sont morts dans les 9 mois.

Le type de résection curative devrait être décidée d'après les données préopératoires sur l'étendue du cancer dans chaque canal hépatique; le traitment comporte la résection du lobe caudé associée à la plus petite segmentectomie hépatique nécessaire possible.

Resumen

Entre 1979 y 1989 se realizó resección quirúrgica en 55 de 66 pacientes con carcinoma del hilio hepático después de mejorar la ictericia mediante el drenaje biliar percutáneo transhepático (DBPT). Se efectuó colangiografía selectiva a través del DBPT con el objeto de definir con precisión la ubicación anatómica, así como la extensión de la lesión obstructiva en los canales hepáticos segmentarios. Se realizó colangioscopia percutánea transhepática a través del tracto de la DBPT después de reemplazar el catéter de drenaje por un catéter French No. 15 para hacer colangiografía superselectiva y biopsia para establecer el diagnóstico definitivo de la extensión histológica del tumor, así como visualizar cualquiera variatión de los canales hepáticos segmentarios que vienen a unirse en el hilio hepático.

En 46 (69.7%) de 66 pacientes fue posible la resección curativa. Cuarenta y cinco de éstos fueron sometidos a diferentes tipos de segmentectomía hepática con lobectomía caudada con una tasa de morbilidad de 41.3% y una tasa de mortalidad operatoria de 6.4%. Catorce (31.1%) casos avanzados fueron sometidos a resección combinada de la vena porta junto con la hepatectomía. Se confirmó invasión tumoral en las ramas caudadas en 44 de 45 pacientes en quienes se practicó resección del lóbulo caudado.

La sobrevida de 3 años de los pacientes que sobrevivieron la resección curativa due 55.1% y la supervivencia a 5 años fue de 40.5%. Todos los 11 pacientes que exhibieron tumor avanzado no resecable murieron dentro de los primeros 9 meses.

La resección curativa debe ser diseñada de acuerdo con los hallazgos preoperatorios relativos a la extensión del cáncer en cada conducto segmentario y la resección del lóbulo caudado debería ser efectuada junto con tan mínima segmentectomía hepática como sea posible.

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Authors and Affiliations

  1. First Department of Surgery, Nagoya University School of Medicine, 65 Tsurumaicho Showaku, 466, Nagoya, Japan

    Yuji Nimura M.D., Naokazu Hayakawa M.D., Junichi Kamiya M.D., Satoshi Kondo M.D. & Shigehiko Shionoya M.D.

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  1. Yuji Nimura M.D.
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  2. Naokazu Hayakawa M.D.
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  3. Junichi Kamiya M.D.
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  4. Satoshi Kondo M.D.
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  5. Shigehiko Shionoya M.D.
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Nimura, Y., Hayakawa, N., Kamiya, J. et al. Hepatic segmentectomy with caudate lobe resection for bile duct carcinoma of the hepatic hilus. World J. Surg. 14, 535–543 (1990). https://doi.org/10.1007/BF01658686

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