Yuji Kaneoka1, Atsuyuki Maeda, Masatoshi Isogai. 1. Department of Surgery, Ogaki Municipal Hospital, 4-86 Minaminokawa, Ogaki, 503-8502, Japan, y-kaneoka@omh.ogaki.gifu.jp.
Abstract
BACKGROUND: En bloc resection of the hepatoduodenal ligament (HDL) for advanced biliary malignancy by hepato-ligamento-pancreatoduodenectomy (HLPD) or hepatoligamentectomy (HL) remains challenging, and only short-term outcomes have been reported. We showed our surgical technique of HLPD and HL, and retrospectively investigated surgical outcomes of the patients. METHODS: Between 2003 and 2014, we performed four HLPD and three HL including major hepatectomy with concomitant caudate lobectomy. Portal vein reconstruction (PVR) was performed with a right external iliac vein graft, and hepatic artery reconstruction (HAR) was accomplished with the heterogeneous artery using the continuous suturing method. RESULTS: Mean operation time and blood loss were 575 ± 111 min and 1539 ± 950 mL, respectively, and patency of the reconstructed vessels was confirmed postoperatively in all cases. Histologically, negative surgical margins (R0) were achieved in 57% of patients, while the resected vascular invasion was confirmed in all patients. Overall morbidity was high at 57%, but we have achieved no postoperative mortality. Overall median survival time of the patients was 36 months, and a patient of HL survived over 5 years. CONCLUSIONS: En bloc resection of the HDL based on steady vascular reconstruction can improve the surgical outcome of biliary cancer in selected patients.
BACKGROUND: En bloc resection of the hepatoduodenal ligament (HDL) for advanced biliary malignancy by hepato-ligamento-pancreatoduodenectomy (HLPD) or hepatoligamentectomy (HL) remains challenging, and only short-term outcomes have been reported. We showed our surgical technique of HLPD and HL, and retrospectively investigated surgical outcomes of the patients. METHODS: Between 2003 and 2014, we performed four HLPD and three HL including major hepatectomy with concomitant caudate lobectomy. Portal vein reconstruction (PVR) was performed with a right external iliac vein graft, and hepatic artery reconstruction (HAR) was accomplished with the heterogeneous artery using the continuous suturing method. RESULTS: Mean operation time and blood loss were 575 ± 111 min and 1539 ± 950 mL, respectively, and patency of the reconstructed vessels was confirmed postoperatively in all cases. Histologically, negative surgical margins (R0) were achieved in 57% of patients, while the resected vascular invasion was confirmed in all patients. Overall morbidity was high at 57%, but we have achieved no postoperative mortality. Overall median survival time of the patients was 36 months, and a patient of HL survived over 5 years. CONCLUSIONS: En bloc resection of the HDL based on steady vascular reconstruction can improve the surgical outcome of biliary cancer in selected patients.
Authors: Peter Neuhaus; Armin Thelen; Sven Jonas; Gero Puhl; Timm Denecke; Wilfried Veltzke-Schlieker; Daniel Seehofer Journal: Ann Surg Oncol Date: 2011-10-01 Impact factor: 5.344
Authors: Moritz Koch; O James Garden; Robert Padbury; Nuh N Rahbari; Rene Adam; Lorenzo Capussotti; Sheung Tat Fan; Yukihiro Yokoyama; Michael Crawford; Masatoshi Makuuchi; Christopher Christophi; Simon Banting; Mark Brooke-Smith; Val Usatoff; Masato Nagino; Guy Maddern; Thomas J Hugh; Jean-Nicolas Vauthey; Paul Greig; Myrddin Rees; Yuji Nimura; Joan Figueras; Ronald P DeMatteo; Markus W Büchler; Jürgen Weitz Journal: Surgery Date: 2011-02-12 Impact factor: 3.982