Extended Left Hepatic Lobectomy and Caudate Lobectomy Combined with Arterio-Portal Shunting for a Case of Hilar Cholangiocarcinoma with Unsuccessful Right Hepatic Arterial Reconstruction

  • Seiki Tashiro
  • Hidenori Miyake


Recently, improvements in techniques and instruments for hepatic resection have made massive hepatectomy safe. Patients with hilar cholangiocarcinoma often require hepatic lobectomy combined with resection of the caudate lobe, as well as resection of the extrahepatic bile duct, to remove cancerous lesions completely.1–3 In cases of left hepatic lobectomy combined with caudate lobectomy, we mobilize the caudate lobe from the left side only. Although sometimes both hepatic lobes are mobilized for complete resection of the caudate lobe, we do not mobilize the right lobe in cases of extended left hepatic lobectomy in order to decrease damage to the remnant liver. This technique is very beneficial for the formation of collateral arterial supply to the right hepatic lobe, as well as for protection against mechanical damage to the right hepatic lobe. In particular, when the right hepatic artery has to be resected and, unfortunately, reconstruction of the artery is unsuccessful in cases of left hepatic lobectomy, collateral arterial flow to the residual right hepatic lobe is very important for a good postoperative prognosis.


Hepatic Artery Hepatic Vein Hepatic Duct Caudate Lobe Hilar Cholangiocarcinoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Mizumoto R, Kawarada Y, Suzuki H (1986) Surgical treatment of hilar carcinoma of the bile duct. Surg Gynecol Obstet 162: 153–158PubMedGoogle Scholar
  2. 2.
    Nimura Y, Hayakawa N, Kamiya J, Kondo S, Nagino M, Kanai M (1995) Hilar cholangiocarcinoma: surgical anatomy and curative resection. J Hepatobiliary Pancreat Surg 2:239–248CrossRefGoogle Scholar
  3. 3.
    Nagakawa T, Kitagawa H, Kayahara M, Ohta T, Konishi I (2000) Spreading patterns of hilar bile duct cancer (in Japanese with an English abstract). J Jpn Surg Soc 101:399–403Google Scholar
  4. 4.
    Mimura H, Takakura N, Kim H, Hamazaki K, Tsuge H, Ochiai Y (1991) Block resection of the hepatoduodenal ligament for carcinoma of the bile duct and gallbladder. Surgical technique and a report of 11 cases. Hepatogastroenterology 38:561–567PubMedGoogle Scholar
  5. 5.
    Endo I, Masunari H, Sugita M, Morioka D, Tanaka K, Togo S, Sekido H, Yoshida T, Shimada H (2001) Indications for combined resection and reconstruction of the hepatic artery in biliary tract carcinoma (in Japanese with an English abstract). J Jpn Surg Soc 102:820–825Google Scholar
  6. 6.
    Miyazaki M, Ito H, Nakagawa K, Ambiru S, Shimizu H, Shimizu Y, Kato A, Nakamura S, Omoto H, Nakajima N, Kimura F, Suwa T (1998) Aggressive surgical approaches to hilar cholangiocarcinoma: hepatic or local resection? Surgery 123:131–136PubMedCrossRefGoogle Scholar
  7. 7.
    Blumgart LH, Benjamin IS (1989) Liver resection for bile duct cancer. Surg Clin North Am 69:323–337PubMedGoogle Scholar
  8. 8.
    Ishiyama S, Fuse A, Kuzu H, Tanaka J, Urayama M, Igarashi Y, Sakurai F, Kawaguchi K, Tsukamoto M, Nakamura T, Koike S (1997) Microsurgical technique used in right anterior seg-mentectomy and pancreatoduodenectomy with reconstruction of the right posterior hepatic artery for widespread bile duct cancer involving the hepatic hilus. J Hepatobiliary Pancreat Surg 4:417–422CrossRefGoogle Scholar

Copyright information

© Springer Japan 2004

Authors and Affiliations

  • Seiki Tashiro
    • 1
  • Hidenori Miyake
    • 1
  1. 1.The University of Tokushima School of MedicineTokushimaJapan

Personalised recommendations