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Right hepatectomy with resection of caudate lobe and extrahepatic bile duct for hilar cholangiocarcinoma

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Abstract

En-bloc liver resection with caudate lobectomy (segmentectomy 1) is the standard procedure for hilar cholangiocarcinoma. Although its surgical mortality has been reduced below 5%, it is still a potentially hazardous operation. Complete tumor resection with negative surgical margins and safe reconstruction of bilio-enteric continuity are two principles of the surgical treatment of hilar cholangiocarcinoma. Surgeons must pay attention to the variation of the hilar structures including portal veins, hepatic arteries, and bile ducts. Three-dimensional imaging is beneficial not only for understanding anatomical variations but also for preoperative simulations. Since the U-point can be identified by both preoperative imaging and intraoperative inspection, it can be used as the landmark for the hepatectomy and the dissection point of the hilar plate. The hanging maneuver might be useful for both hepatic parenchymal dissection and bile duct dissection just right of the U-point. For safe biliary reconstruction, stay sutures in the anterior wall and transanastomotic stents may be helpful.

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References

  1. 1.

    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. 1990;14:535–44.

  2. 2.

    Miyagawa S, Makuuchi M, Kawasaki S. Outcome of extended right hepatectomy after biliary drainage in hilar bile duct cancer. Arch Surg. 1995;130:759–63.

  3. 3.

    Miyazaki M, Ito H, Nakagawa K, et al. Aggressive surgical approaches to hilar cholangiocarcinoma: hepatic or local resection? Surgery. 1998;123:131–6.

  4. 4.

    Mizumoto R, Kawarada Y, Suzuki H. Surgical treatment of hilar carcinoma of the bile duct. Surg Gynec Obstet. 1986;162:153–8.

  5. 5.

    Kawasaki S, Imamura H, Kobayashi A, et al. Results of surgical resection for patients with hilar bile duct cancer; application of extended hepatectomy after biliary drainage and hemihepatectic portal vein embolization. Ann Surg. 2003;238:84–92.

  6. 6.

    Kondo S, et al. Forty consecutive resections of hilar cholangiocarcinoma with no postoperative mortality and no positive ductal margins: results of a prospective study. Ann Surg. 2004;240:95–101.

  7. 7.

    Igami T, Nishio H, Ebata T, Yokoyama Y, Sugawara G, Nimura Y, et al. Surgical treatment of hilar cholangiocarcinoma in the “new era”: the Nagoya University experience. J Hepatobiliary Pancreat Sci. 2010;17:449–54.

  8. 8.

    Jarnagin WR, D’Angelica M, Blumgart LH. Intrahepatic and extrahepatic biliary cancer. In: Blumgart LH, editor. Surger of the liver, biliary tract, and pancreas. 4th ed. Philadelphia: Saunders; 2007. p. 782–826.

  9. 9.

    Bismuth H, Nakache R, Diamond J. Management strategies in resection for hilar cholangiocarcinoma. Ann Surg. 1992;215:31–8.

  10. 10.

    Endo I, Shimada H, Sugita M, Fujii Y, Morioka D, Takeda K, et al. Role of three-dimensional imaging in operative planning for hilar cholangiocarcinoma. Surgery. 2007;142:666–75.

  11. 11.

    Makuuchi M, Thai BL, Takayama K, et al. Preoperative portal embolization for hilar bile duct carcinoma: a preliminary report. Surgery. 1990;107:521–7.

  12. 12.

    Kondo S, Katoh H, Hirano S, Ambo Y, Tanaka E, Okushiba S. Portal vein resection and reconstruction prior to hepatic dissection during right hepatectomy and caudate lobectomy for hepatobiliary cancer. Br J Surg. 2003;90:694–7.

  13. 13.

    Miyazaki M, Ito H, Nakagawa K, Ambiru S, Shimizu H, Ohtuka M, et al. Vascular reconstruction using left renal vein graft in advanced hepatobiliary malignancy. Hepatogastroenterology. 1997;44:1619–23.

  14. 14.

    Belghiti J, et al. Liver hanging maneuver: a safe approach to right hepatectomy without liver mobilization. J Am Coll Surg. 2001;193:109–11.

  15. 15.

    Nagino M, Kamiya J, Arai T, Nishio H, Ebata T, Nimura Y. “Anatomic” right hepatic trisectionectomy (extended right hepatectomy) with caudate lobectomy for hilar cholangiocarcinoma. Ann Surg. 2006;243:28–32.

  16. 16.

    Bismuth H, Corlette MB. Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver. Surg Gynecol Obstet. 1975;140:170–8.

  17. 17.

    Fortner JG, Kallum BO, Kim DK. Surgical management of carcinoma of the junction of the main hepatic ducts. Ann Surg. 1976;184:68–73.

  18. 18.

    Blumgart LH, Hadis NS, Benjamin IS, Beasley R. Surgical approaches to cholangiocarcinoma at confluence of hepatic ducts. Lancet. 1984;14:66–9.

  19. 19.

    Tsuzuki T, Uekusa M. Carcinoma of the proximal bile ducts. Surg Gynec Obstet. 1978;146:933–43.

  20. 20.

    Tashiro S, Tsuji T, Kanemitsu K, et al. Prolongation of survival for carcinoma at the hepatic duct confluence. Surgery. 1993;113:270–8.

  21. 21.

    Sugiura Y, Nakamura S, Iida S, et al. Extensive resection of the bile ducts combined with liver resection for cancer of the main hepatic duct junction: a cooperative study of the Keio Bile Duct Cancer Study Group. Surgery. 1994;115:445–51.

  22. 22.

    Jarnagin WR, Fong Y, DeMatteo RP, Gonen M, Burke EC, Bodniewicz BSJ, et al. Staging and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg. 2001;234:507–19.

  23. 23.

    Lygidakis NJ, van der Heyde MN, van Dongen RJAM, Kromhout JG, Tytgat GNJ, Huibregtse K. Surgical approaches for unresectable primary carcinoma of the hepatic hilus. Surg Gynecol Obstet. 1988;166:107–14.

  24. 24.

    Sakaguchi S, Nakamura S. Surgery of the portal vein in resection of cancer of the hepatic hilus. Surgery. 1986;99:344–9.

  25. 25.

    Nimura Y, Hayakawa N, Kamiya J, Maeda S, Kondo S, Yasui A, et al. Combined portal vein and liver resection for carcinoma of the biliary tract. Br J Surg. 1991;78:727–31.

  26. 26.

    Neuhaus P, Jonas S, Bechstein WO, Lohmann R, Radke C, Kling N, et al. Extended resection for hilar cholangiocarcinoma. Ann Surg. 1999;230:808–19.

  27. 27.

    Hirano S, Kondo S, Tanaka E, Shichinohe T, Tsuchikawa T, Kato K. No-touch resection of hilar malignancies with right hepatectomy and routine portal reconstruction. J Hepatobiliary Pancreat Surg. 2009;16:502–7.

  28. 28.

    Nagino M, Kamiya J, Nishio H, Ebata T, Arai T, Nimura Y. Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer: surgical outcome and long-term follow-up. Ann Surg. 2006;243:364–72.

  29. 29.

    Ebata T, Nagino M, Kamiya J, Uesaka K, Nagasaka T, Nimura Y. Hepatectomy with portal vein resection for hilar cholangiocarcinoma: audit of 52 consecutive cases. Ann Surg. 2003;238:720–7.

  30. 30.

    Miyazaki M, Kimura F, Shimizu H, Yoshidome H, Ohtsuka M, Kato A, et al. Recent advance in the treatment of hilar cholangiocarcinoma: hepatectomy with vascular resection. J Hepatobiliary Pancreat Surg. 2007;14:463–8.

  31. 31.

    Hemming AW, Mekeel K, Khanna A, Baquerizo A, Kim RD. Portal vein resection in management of hilar cholangiocarcinoma. J Am Coll Surg. 2011;212:604–13.

  32. 32.

    Denecke T, Degutyte E, Stelter L, Lehmkuhl L, Valencia R, Lopez-Hanninen E, et al. Minimal intensity projections of the biliary system using 16-channel multidetector computed tomography in patients with biliary obstruction: comparison with MRCP. Eur Radiol. 2006;16:1719–26.

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Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Correspondence to Itaru Endo.

Additional information

This article is based on the studies first reported in Highly Advanced Surgery for Hepato-Biliary-Pancreatic Field (in Japanese), Tokyo: Igaku-Shoin, 2010.

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Endo, I., Matsuyama, R., Taniguchi, K. et al. Right hepatectomy with resection of caudate lobe and extrahepatic bile duct for hilar cholangiocarcinoma. J Hepatobiliary Pancreat Sci 19, 216–224 (2012) doi:10.1007/s00534-011-0481-7

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Keywords

  • Hilar cholangiocarcinoma
  • 3DCT
  • Caudate lobe
  • Right hemihepatectomy
  • Trisectionectomy
  • Hanging maneuver