Hepatectomy and pylorus-preserving pancreatoduodenectomy with reconstruction of the hepatic artery, using the middle colic artery, for bile duct carcinoma: A case report

Sekido, Hitoshi; Shimada, Hiroshi; Nakano, Akira; Endo, Itaru; Fujii, Satoshi

doi:10.1007/bf01222250

Cited by 3 publications

(4 citation statements)

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“…Many reports have described hepatectomies combined with vascular resection and reconstruction for biliary malignancy [2, 4, 10, 11, 12, 13, 14, 15, 16, 17, 18], but few have described the survival effects or indications [1]. Neuhaus et al [8] and Ishiyama et al [19] reported in multivariate analyses after R0 resection that additional resection of the portal vein was the only variable with a significant influence on the survival of patients with hilar cholangiocarcinoma.…”

Section: Discussionmentioning

confidence: 99%

Hepatic Resection Combined with Portal Vein or Hepatic Artery Reconstruction for Advanced Carcinoma of the Hilar Bile Duct and Gallbladder

et al. 2003

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Hepatectomy with vascular reconstruction for biliary malignancy remains controversial. This study aimed to clarify the indications for surgery. Patients with advanced hilar bile duct cancer (HBDC) (n = 26) and gallbladder cancer (GBC) involving the hepatoduodenal ligament (n = 13) who underwent hepatectomy were enrolled. They were divided into two groups on the basis of whether vascular reconstruction was performed (HBDC, 10 yes vs. 16 no; GBC, 5 yes vs. 8 no). Portal vein (PV) reconstruction was performed on the right branch in seven patients and on the left branch in two; hepatic artery (HA) reconstruction was done on the right branch in 11 patients and on the left branch in 1. Five patients with HBDC and one with GBC underwent both PV and HA reconstruction. Patency rates were 88.0% and 83.3% for PV and HA reconstructions, respectively. Vascular reconstruction-related morbidity occurred in one patient with fatal liver failure owing to a portal thrombus and in two patients with multiple liver abscesses caused by arterial obstruction. Microsurgery eliminated reconstruction-related morbidity. Mortality in vascular reconstruction cases was 13.3% (2/15), and in those without reconstruction it was 8.3% (2/24). Curability rates (R0 and R1+R2) were 50.0% and 56.0% for HBDC and 40.0% and 62.5% for GBC, respectively. The 3-year survivals of HBDC patients were, respectively, 33% and 42%, and the 5-year survivals were 18% and 25%, whereas for GBC the 1-year survivals were 20% and 60% and the 2-year survivals 0% and 25%. Two patients with vascular involvement who underwent PV with HA reconstruction survived more than 3 years. Hepatectomy with vascular reconstruction for selected HBDC patients offers low surgical risk and increased survival by curable resection, but it is not recommended for advanced GBC.

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Section: Discussionmentioning

confidence: 99%

Hepatic Resection Combined with Portal Vein or Hepatic Artery Reconstruction for Advanced Carcinoma of the Hilar Bile Duct and Gallbladder

et al. 2003

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“…Short segments of hepatic artery encased by tumor have been successfully resected and reconstructed by either primary anastomosis or reversed saphenous vein interposition graft (32). Another technical option is to anastomose the distal stump of the resected rRHA to the stump of the gastroduodenal artery, to the splenic artery (in an end-to-end or end-to-side fashion) using a saphenous vein jump graft (27), or to the middle colic artery (33). Another option for vein graft could be the gonadal vein (34).…”

Section: Discussion Discussionmentioning

confidence: 99%

New criterion for borderline resectable pancreatic cancer: Invasion of a replaced right hepatic artery

Botea¹,

Dumitraşcu²,

Zamfirescu³

et al. 2016

JTMR

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Background: Loco-regional invasion is not uncommon in a patient diagnosed with a pancreatic cancer. A negative resection margins pancreatectomy represents the most important determining factor of survival in patients resected for pancreatic adenocarcinoma. Thus, in order to increase resectability in such patients, extended pancreatectomies were proposed in so-called borderline resectable tumors, including venous, arterial or other surrounding organs removal. Case presentation: A 52-year old male, with pancreatic head cancer invasive into the portal vein and replaced right hepatic artery (rRHA)(from superior mesenteric artery), underwent pancreatico-duodenectomy (PD) with portal vein resection and reconstruction, segmental resection of the rRHA and associated right hemi-hepatectomy. Results: The postoperative outcome was remarkably uneventful except for a self-limited minor bile leak. Negative resection margins of the operative specimen were observed at pathological examination. Conclusion: Proper assessment of the presence and course of a rRHA prior to PD is mandatory for a safe surgery. Invasion of the rRHA is not a contraindication for resection in a patient with pancreatic head cancer and should be included among the borderline resection criteria. Associated right hemi-hepatectomy is a safe option for such a patient in order to achieve negative resection margins.

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“…Radical management, associated with vascular resection and reconstruction, in attempts to increase resectability and preserve liver parenchyma, has recently been reported, and various types of reconstruction have been performed . However, postoperative liver abscess or bilio‐enteric anastomosis leakage caused by ischemia due to arterial stenosis sometimes occur and are often fatal.…”

Section: Discussionmentioning

confidence: 99%

“…Sekido et al7 also reported microsurgical arterial reconstruction, using the middle colic artery, in hepatectomy and pylorus‐preserving pancreatoduodenectomy for bile duct carcinoma. Although obstruction of the anastomosis was found on the arteriogram 2 months after surgery, the patient recovered, as there was a blood supply through rapidly formed collateral vessels.…”

Section: Discussionmentioning

confidence: 99%

Microsurgical technique used in right anterior segmentectomy and pancreatoduodenectomy with reconstruction of the right posterior hepatic artery for widespread bile duct cancer involving the hepatic hilus

Ishiyama

Fuse

Kuzu

et al. 1997

J Hep Bil Pancr Surg

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Abstract:A microsurgical technique was used in performing anterior hepatic segmentectomy and pancreatoduodenectomy with reconstruction of the posterior hepatic artery in a 64-year-old man with widespread bile duct cancer from the intrapancreatic bile duct over the hepatic hilus. The anterior hepatic artery was obviously involved and the posterior hepatic artery just behind common hepatic duct was very close to the cancer. Microsurgical anastomosis between the remnant gastroduodenal artery and the posterior hepatic artery at the hepatic hilus made it possible to preserve the posterior segment of the liver and to perform a curative resection of the cancer. The patient had pyrexia because of suprahepatic abscess after the operation, but the abscess drained spontaneously. Postoperative arteriogram showed neither obstruction nor kinking of the reconstructed artery. He was discharged 2 months after surgery and has been enjoying a normal quality of life for 10 months since, with no signs of recurrence. It is suggested that a microsurgical technique is useful for performing an accurate anastomosis with good patency that allows not only a safe but also a highly curative operation for advanced bile duct cancer.

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Hepatectomy and pylorus-preserving pancreatoduodenectomy with reconstruction of the hepatic artery, using the middle colic artery, for bile duct carcinoma: A case report

Cited by 3 publications

References 2 publications

Hepatic Resection Combined with Portal Vein or Hepatic Artery Reconstruction for Advanced Carcinoma of the Hilar Bile Duct and Gallbladder

Hepatic Resection Combined with Portal Vein or Hepatic Artery Reconstruction for Advanced Carcinoma of the Hilar Bile Duct and Gallbladder

New criterion for borderline resectable pancreatic cancer: Invasion of a replaced right hepatic artery

Microsurgical technique used in right anterior segmentectomy and pancreatoduodenectomy with reconstruction of the right posterior hepatic artery for widespread bile duct cancer involving the hepatic hilus

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