Surgery of the portal vein in resection of cancer of the hepatic hilus.

Resectability of cancer that has invaded the hepatic hilus is still very low, mainly because of the invasion of the cancer to the confluence of the portal veins. Resection of the tumor with right hepatic trisegmentectomy accompanied by resection of the portal vein invaded by the tumor was performed on three patients suffering from cancer of the intrahepatic bile duct, two with cancer of the upper bile duct and three with cancer of the gallbladder. Reconstruction of the portal vein was achieved by end-to-end anastomosis between the left hepatic branch and the trunk, except in one patient in whom an autovein was grafted. There was one postoperative death. There were no unpleasant symptoms caused by portal vein reconstruction in the remaining patients and there was one case of long survival (55 months). Although the significance of this surgery for patient survival is not yet clear, the procedure may elevate the rate of resectability of advanced cancer invading the hepatic hilus. The indication and special technical points of the procedure are described.