Hepatic segmentectomy with caudate lobe resection for bile duct carcinoma of the hepatic hilus

Abstract

From 1979 through 1989, surgical resection was performed in 55 of 66 patients with carcinoma of the hepatic hilus after improving jaundice by percutaneous transhepatic biliary drainage (PTBD). Selective cholangiography through PTBD was done to define precisely the anatomical location--extent of the obstructing lesion in each segmental hepatic duct. Percutaneous transhepatic cholangioscopy was performed through the sinus tract of PTBD after replacing the drainage catheter with a 15 French catheter for superselective cholangiography and biopsy to make the definitive diagnosis of the histological extent of the tumor and any variation of each segmental hepatic duct that joins the hepatic hilus. In 46 (69.7%) of 66 patients, curative resection was possible. Forty-five of these underwent various types of hepatic segmentectomy with caudate lobectomy for a morbidity rate of 41.3% and an operative mortality rate of 6.4%. Fourteen (31.1%) advanced cases underwent combined resection of the portal vein together with hepatectomy. Microscopic tumor involvement in the caudate branches was confirmed in 44 of 45 patients who underwent caudate lobe resection. The 3-year survival rate for all 43 patients surviving the curative excision was 55.1% and the 5-year survival rate was 40.5%. All 11 patients who had an unresectable advanced tumor died within 9 months. Curative resection should be designed according to the preoperative findings of the extent of cancer in each segmental duct, and caudate lobe resection should be performed together with the smallest necessary hepatic segmentectomy possible.

Clinical practice guidelines for the management of biliary tract cancers 2015: the 2nd English edition

“…(Grade 1, evidence level B) Statement: Bile ducts of caudate lobe confluent into the bifurcation of left and right bile duct. These branches are frequently invaded by hilar/upper bile duct carcinoma [138][139][140][141]. According to these facts, some reports describe that the combined caudate lobe resection should be designed so that curative surgery for advanced hilar bile duct carcinoma can be performed [141].…”

Hilar cholangiocarcinoma fifteen-year experience with 243 patients at a single Egyptian center

“…2,15,16 In the present study, we observed a 16% 5-year survival rate.These poor results could be due to late diagnoses and presences of liver cirrhosis in 46% of our patients Since the first successful liver and bile duct resection for the treatment of HCCA, there has been a debate about the extent of resection (localized or extensive). 11,[17][18][19] In our experience, skeletonization resection of the extrahepatic biliary system is rarely sufficient to ensure radical treatment of the tumor because it must be combined with liver resection and even with caudate resection and biliary anastomosis in the first and second order ducts of the residual liver. In this study, 30.5% of patients underwent localized resection and 69.5% underwent major resection with median survival rates of 18 and 22 months, respectively, with no significant differences between the two groups (P<0.106) these results are similar to those observed in some studies 20 and contrary to those in other reports.…”

“…Better prognoses have been shown to be associated with resection rather than with palliative treatment. [10][11][12][13][14] In our study, in those patients who underwent laparotomy and had tumors that were underestimated at the preoperative evaluation, such as those exhibiting peritoneal and or metastatic spread, palliative treatment in the form of biliary decompression was obtained by different methods (transmural drainage and surgical endoprothesis). Infiltration of the portal vein (main trunk or bifurcation without vascular thrombosis) or involvement of the local or locoregional lymph nodes and/or the adjacent liver are not absolute contraindications for resection.…”

“…3,25 The concept of the importance of caudate lobe resection in association with hepatectomy in HCCA patients was adopted in recent years as it usually infiltrated with the tumors varying from 48% to 96%. 11,27 The value of this resection is now accepted, with a 5-year survival rate of 46% in those patients who underwent caudate lobe resection in comparison with 12% in patients without caudate lobe resection. 27 In our study, 42% of patients underwent segment I resection in addition to hepatectomy and had a median survival of 27 months that was significantly higher than patients who did not undergo the procedure (58% with a median survival of 17 months; P=0.001).…”

Role of Preoperative Biliary Drainage in Resectable Hilar Cholangiocarcinoma

“…A preoperative bilirubin level lower than 3 mg/dl has been recommended by Makuuchi et al [39] and Nimura et al [40], thus suggesting an important role of PBD in managing HC. A recent single center retrospective study [41] reviewed a 10 years' experience of 105 patients treated for HC.…”