Hepatectomy With Simultaneous Resection of the Portal Vein and Hepatic Artery for Advanced Perihilar Cholangiocarcinoma

Nagino, Masato; Nimura, Yuji; Nishio, Hisahide; Ebata, Tomoki; Igami, Tsuyoshi; Matsushita, Masayuki; Nishikimi, Naomichi; Kamei, Yuzuru

doi:10.1097/sla.0b013e3181e463a7

Cited by 275 publications

(294 citation statements)

References 41 publications

Supporting

Mentioning

287

Contrasting

Unclassified

Order By: Relevance

“…They reach 66% of R0 resection with 2% mortality rate, 54% morbidity rate and 1-, 3-, and 5-year survival rates of 78.9%, 36.3%, and 30.3%, respectively, but these data are not reproducible [86] . Su et al [39] , Miyazaki et al [87] and Muñoz et al [91] reported as a conclusion that, although both portal vein and hepatic artery resection are independent poor prognostic factors after curative operative resection for locally advanced HCC, portal vein resection is acceptable from an operative risk perspective and might improve the prognosis in the selected patients, but combined hepatic artery resection cannot be justified because the 3-year survival rate is 0%.…”

Section: Vascular Resectionmentioning

confidence: 89%

Outcome of surgical resection in Klatskin tumors

Serrablo

Tejedor²

2013

WJGO

View full text Add to dashboard Cite

vein embolization and staging laparoscopy should be considered in selected patients. Additional evidence is needed to fully define the role of orthotopic liver transplant. Portal and lymph node involvement worsen the prognosis and long-term survival, and surgery is the only option that can lengthen it. Improvements in adjuvant therapy are essential for improving long-term outcome. Furthermore, the lack of effective chemotherapy drugs and radiotherapy approaches leads us to can consider R1 resection as an option, because operated patients have a longer survival rate than those who not undergo surgery. INTRODUCTIONCarcinomas arising from the confluence of the hepatic ducts were first described by Altemeier et al [1] . Klatskin [2] Alejandro Serrablo, Luis Tejedor Outcome of surgical resection in Klatskin tumors TOPIC HIGHLIGHT AbstractCholangiocarcinomas are the second most frequent primary hepatic malignancy, and make up from 5% to 30% of malignant hepatic tumours. Hilar cholangiocarcinoma (HCC) is the most common type, and accounts for approximately 60% to 67% of all cholangiocarcinoma cases. There is not a staging system that permits us to compare all series and extract some conclusions to increase the long-survival rate in this dismal disease. Neither the extension of resection, according to the sort of HCC, is a closed topic. Some authors defend limited resection (mesohepatectomy with S1, S1 plus S4b-S5, local excision for papillary tumours, etc .) while others insist in the compulsoriness of an extended hepatic resection with portal vein bifurcation removed to reach cure. As there is not an ideal adjuvant therapy, R1 resection can be justified to prolong the survival rate. Morbidity and mortality rates changed along the last decade, but variability is the rule, with morbidity and mortality rates ranging from 14% to 76% and from 0% to 19%, respectively. Conclusion: Surgical resection continues to be the main treatment of HCC. Negative resection margins achieved with major hepatic resections are associated with improved outcome. Preresectional management with biliary drainage, portal José M Ramia, MD, PhD, Series Editor

show abstract

Section: Vascular Resectionmentioning

confidence: 89%

Outcome of surgical resection in Klatskin tumors

Serrablo

Tejedor²

2013

WJGO

View full text Add to dashboard Cite

show abstract

“…65 Other prognostic factors after R0 resection for CCA include lymph node metastasis, perineural invasion and combined vascular resection due to portal vein and/ or hepatic artery invasion. 1,54,[66][67][68] In hilar CCA, the invasion depth of the tumour (!5 mm versus <5 mm) has been reported to be a better predictor of long-term outcome than the American Joint Committee on Cancer staging system. 69 In patients with ICC, the macroscopic histopathology has been shown to be useful for predicting survival after hepatectomy, with the massforming plus periductal infiltrating type having a more unfavourable prognosis than the mass-forming type.…”

Section: -57mentioning

confidence: 99%

A review of the clinical diagnosis and therapy of cholangiocarcinoma

2013

View full text Add to dashboard Cite

Cholangiocarcinoma (CCA) is the second most common primary hepatic malignancy worldwide. The incidence of intrahepatic CCA is increasing, whereas that of extrahepatic CCA is decreasing. This review looks at the new advances that have been made in the management of CCA, based on a PubMed and Science Citation Index search of results from randomized controlled trials, reviews, and cohort, prospective and retrospective studies. Aggressive interventional approaches and new histopathological techniques have been developed to make a histological diagnosis in patients with high risk factors or suspected CCA. Resectability of the tumour can now be assessed using multiple radiological imaging studies; the main prognostic factor after surgery is a histologically negative resection margin. Biliary drainage and/or portal vein embolization may be performed before extended radical resection, or liver transplantation may be undertaken in combination with neoadjuvant chemotherapy or chemoradiotherapy. Though many advances have been made in the management of CCA, the standard modality of treatment has not yet been established. This review focuses on the clinical options for different stages of CCA.

show abstract

“…in this series. Some investigators advocated the use of microscope for hepatic artery reconstructions in this type of operation (1,2,6). However, the outer diameter of the proper hepatic artery is approximately 5 mm.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, they concluded that such operations could not be justified. On the other hand, Nagino et al (2) reported the acceptable mortality of cholangiocarcinoma operation with simultaneous resections and reconstructions of the portal vein and the hepatic artery. Nevertheless, this operation is one of the most complicated and the most challenging ones in abdominal surgeries.…”

Section: Introductionmentioning

confidence: 99%

Left hepatectomy with simultaneous hepatic artery and portal vein reconstructions in the operation for cholangiocarcinoma: the surgical techniques comprised of step-by-step established procedures

Uchiyama

Shirabe

Araki

et al. 2017

Transl. Gastroenterol. Hepatol.

View full text Add to dashboard Cite

Hepatectomy needing simultaneous reconstruction of the hepatic artery and the portal vein in the operation for cholangiocarcinoma is a challenging procedure. We experienced three cases of left hepatectomy with simultaneous reconstructions of the right hepatic artery (RHA) and the right portal vein (RPV) in all of which the surgical procedures were performed in the same manner. At the initial step of the procedure, we confirmed that the RHA and the RPV at the porta hepatis as well as the proper hepatic artery and the main portal vein (MPV) proximal to the cancer involvement could be controlled by tapes, which meant the cancer could be resected by means of vascular reconstructions. All the vascular reconstructions were performed under loupe magnification. The mean periods of portal and arterial ischemic time of the remnant liver were 14 min. 32 sec. and 35 min. 58 sec., respectively. The mean operative time and the intraoperative blood loss were 627 min. and 804 mL, respectively. No serious postoperative complication occurred. By performing step-by-step well-established procedures, this complicated and challenging operation could be safely completed.

show abstract

Hepatectomy With Simultaneous Resection of the Portal Vein and Hepatic Artery for Advanced Perihilar Cholangiocarcinoma

Abstract: Major hepatectomy with simultaneous resection and reconstruction of the portal vein and hepatic artery is technically demanding. However, this surgery can be performed with acceptable mortality by an experienced surgeon and offers a better chance of long-term survival in selected patients.

Cited by 275 publications

References 41 publications

Outcome of surgical resection in Klatskin tumors

Outcome of surgical resection in Klatskin tumors

A review of the clinical diagnosis and therapy of cholangiocarcinoma

Left hepatectomy with simultaneous hepatic artery and portal vein reconstructions in the operation for cholangiocarcinoma: the surgical techniques comprised of step-by-step established procedures

Contact Info

Product

Resources

About