BACKGROUND: En-bloc liver resection with the extrahepatic bile duct is mandatory to obtain tumour-free surgical margins and better long-term outcomes in hilar cholangiocarcinoma (CC). One of the most important criteria for irresectability is local extensive invasion to major vessels. As hilar CC Bismuth type IIIB often requires a major left hepatic resection, the invasion of the right hepatic artery (RHA) usually contraindicates this procedure. METHODS: The authors describe a novel technique that allowed an oncological resection in two patients with hilar CC Bismuth type IIIB and contralateral arterial invasion. Arterial reconstruction between the posterior branch of the RHA and the left hepatic artery (LHA) was performed as the first surgical step. Once arterial vascular flow was restored, a left trisectionectomy with caudate lobe resection and portal vein reconstruction was performed. RESULTS: In both patients an R0 resection was achieved. Both patients made a full recovery and were discharged within 14 days of surgery. Both patients remain free of disease at 18 months. CONCLUSIONS: This new technique allows a R0 resection to be achieved in patients with Bismuth type IIIB hilar CC with contralateral arterial involvement.
BACKGROUND: En-bloc liver resection with the extrahepatic bile duct is mandatory to obtain tumour-free surgical margins and better long-term outcomes in hilar cholangiocarcinoma (CC). One of the most important criteria for irresectability is local extensive invasion to major vessels. As hilar CC Bismuth type IIIB often requires a major left hepatic resection, the invasion of the right hepatic artery (RHA) usually contraindicates this procedure. METHODS: The authors describe a novel technique that allowed an oncological resection in two patients with hilar CC Bismuth type IIIB and contralateral arterial invasion. Arterial reconstruction between the posterior branch of the RHA and the left hepatic artery (LHA) was performed as the first surgical step. Once arterial vascular flow was restored, a left trisectionectomy with caudate lobe resection and portal vein reconstruction was performed. RESULTS: In both patients an R0 resection was achieved. Both patients made a full recovery and were discharged within 14 days of surgery. Both patients remain free of disease at 18 months. CONCLUSIONS: This new technique allows a R0 resection to be achieved in patients with Bismuth type IIIB hilar CC with contralateral arterial involvement.
Authors: W R Jarnagin; Y Fong; R P DeMatteo; M Gonen; E C Burke; J Bodniewicz BS; M Youssef BA; D Klimstra; L H Blumgart Journal: Ann Surg Date: 2001-10 Impact factor: 12.969
Authors: Alastair L Young; K Rajendra Prasad; Robert Adair; Mohammed Abu Hilal; J Ashley Guthrie; J Peter A Lodge Journal: J Am Coll Surg Date: 2008-08-30 Impact factor: 6.113
Authors: P Neuhaus; S Jonas; W O Bechstein; R Lohmann; C Radke; N Kling; C Wex; H Lobeck; R Hintze Journal: Ann Surg Date: 1999-12 Impact factor: 12.969
Authors: M Miyazaki; H Ito; K Nakagawa; S Ambiru; H Shimizu; H Yoshidome; Y Shimizu; T Okaya; N Mitsuhashi; Y Wakabayashi; N Nakajima Journal: Hepatogastroenterology Date: 2000 Nov-Dec
Authors: Sung Gyu Lee; Gi Won Song; Shin Hwang; Tae Yong Ha; Deok Bog Moon; Dong Hwan Jung; Ki Hun Kim; Chul Soo Ahn; Myung Hwan Kim; Sung Koo Lee; Kyu Bo Sung; Gi Young Ko Journal: J Hepatobiliary Pancreat Sci Date: 2009-10-23 Impact factor: 7.027