Modified hepatoduodenal ligamentectomy for advanced carcinoma of the biliary tract: The importance of preservation of the replaced left hepatic artery

Mizutani, Takashi; Maeta, Hajime; Wakabayashi, Hisao; Okada, Setsuo; Mori, Satoshi; Karasawa, Yukihiko

doi:10.1007/s005340050049

Cited by 7 publications

(5 citation statements)

References 4 publications

(10 reference statements)

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“…Only a limited number of 5‐year survivors with LN metastasis have been reported to date, and Table 10 shows our 6 long‐term survivors with LN metastasis after resection. Of note, one patients whose 3 of 8 paraaortic LNs showed metastasis (8 of a total of 24 excised LNs revealed metastasis) is alive more than 14 years with no sign of recurrence after modified hepato‐ligamento‐pancreatoduodenectomy (Table 10) [26]. The fact that long‐term survival is possible even in pN 1 or pM 1 disease encourages surgeons to perform an aggressive surgical resection with extended LN dissection in selected patients with hilar cholangiocarcinoma.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of hilar cholangiocarcinoma in the new era: the Asan experience

Lee

Song

Hwang

et al. 2009

J Hepato Biliary Pancreat

234

195

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Background/purpose Both curative resection and minimized in-hospital mortality offer the only chance of longterm survival in patients with hilar cholangiocarcinoma. The reported resectability rates for hilar cholangiocarcinoma have increased by virtue of combined major hepatectomy, but this procedure is technically demanding and still associated with a significant morbidity and mortality that must be carefully balanced against the chances of longterm survival. Methods Between January 2001 and December 2008, 350 patients with hilar cholangiocarcinoma underwent exploration for the purpose of potentially curative resection, of whom 302 (86.3%) were resected in the Department of Hepato-Biliary Surgery and Liver Transplantation, Asan Medical Center, University of Ulsan College of Medicine. Combined hepatectomy was carried out in 268 (88.7%) of 302 resected patients. Major hemihepatectomy and parenchyma-preserving hepatectomy were performed in 257 and 11 patients, respectively. Portal vein resection was associated in 40 (14.9%) of 268 hepatectomized patients.To control preoperative cholangitis and reduce risk of postoperative hepatic failure, biliary decompression through endoscopic and/or percutaneous transhepatic drainage and portal vein embolization were preoperatively applied in 329 (94.0%) of 350 explored patients and in 91 (54.2%) of 168 extended hepatectomized patients (154 right hemihepatectomy, 9 right trisectionectomy, 5 left trisectionectomy), respectively. Liver transplantation was not performed as primary treatment for hilar cholangiocarcinoma. Results There were 5 cases (1.7%) of in-hospital death after resection and 1 postoperative liver failure that was successfully treated with liver transplantation. Major complications were encountered in 23 patients (7.0%), and the overall morbidity rate was 43%. In 302 resections, 214 (70.9%) were curative resections (R0) and 88 (29.1%) were palliative resections (R1). The overall 1-, 3-and 5-year survival rates after resection, including in-hospital deaths, were 84.6, 50.7 and 47.3% in the R0 group and 69.9, 33.3 and 7.5% in the R1 group, respectively. The 5-year survival rate of extended hemihepatectomy of 36.4% was better than that of parenchyma-preserving hepatectomy at 10.5%. Two significant predictive factors adversely affecting survival after resection were lymph node metastasis and incurability of surgery (P \ 0.001). Two patients with vascular involvement who underwent concomitant hepatic artery and portal vein reconstruction are alive after more than 3 years. Conclusion Preoperative biliary decompression and portal vein embolization enabled us to reduce in-hospital deaths associated with extended hepatectomy for hilar cholangiocarcinoma. Major hemihepatectomy offers an increased survival because of the higher possibility of curative resection than bile duct resection alone and parenchyma-preserving hepatectomy, but it still carries a certain mortality. Less extensive procedures can be

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Section: Discussionmentioning

confidence: 99%

Surgical treatment of hilar cholangiocarcinoma in the new era: the Asan experience

Lee

Song

Hwang

et al. 2009

J Hepato Biliary Pancreat

234

195

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“…Regarding the width of the ligament, we found that there were two periods of accelerated development (4-5 months and 9 monthsnewborns) and a period of slow development (5-8 months). It is worth noting that at some stage of development (6 months), the length of the hepatic-duodenal ligament is even slightly reduced, which can probably be associated with an increase in the adjacent organs -the liver and the duodenum in this period [13][14][15][16][17][18][19][20].…”

Section: Discussionmentioning

confidence: 99%

Organometric parameters of hepatoduodenal ligament n the perinatal period

Yuzko

Слободян

2019

Rep. of Morph.

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During any surgery, in addition to pathology-related factors, it is necessary to evaluate the individual features of the anatomy of a particular area or complex of organs. The relevance of such data is confirmed by the results of numerous studies that show that half of patients are characterized by certain anatomical variants, including the location of the arteries and biliary tract. The purpose of the work is to establish the peculiarities of the morphometric parameters of the components of the hepatic-duodenal ligament. The study was based on 50 preparations of fetus corpses (4 to 10 months) and 10 newborns without external signs of anatomical abnormalities or congenital malformations. Adequate anatomical methods were used during the study: macropreparation, injection of blood vessels, making topographic anatomical sections, morphometry. Statistical analysis of the obtained data was performed using the licensed program RStudio. During the perinatal period, the length of the hepatic-duodenal ligament was found to increase from 5.224±0.572 mm in fetuses for 4 months to 32.12±1.77 mm in newborns. The chart of change of the average values of its length by months of prenatal development indicates uneven increase of organometric parameters. From 4 to 5 months observed a significant increase in the length of the hepatic-duodenal ligament, while from 5 to 7 months of development observed a period of relative slowdown of its length, and from 5 to 6 months of development even a relative decrease in length. The period from 7 to 10 months determines the period of accelerated growth of ligament. The indices of the width of the hepatic-duodenal ligament in the perinatal period increased from 3.292±0.227 mm in fetus of 4 months to 21.25±0.938 mm in newborns. The width increases are not uniform. The periods of accelerated development (4-5 months and 9 months – newborns) and the period of slow development (5-8 months) were observed. It was proved that there are periods of accelerated and slow development, in which during periods of intensive development, organometric indicators always differed significantly, were smaller than the previous ones and outweighed the following ones respectively (4-5 months and 7-9 months, р˂0.05). Regarding the periods of slow development, the organometric indicators in these periods did not differ significantly (р˃0.05). Therefore, analyzing the dynamics of changes in the morphometric parameters of the components of the hepatic-duodenal ligament, revealed periods of their accelerated and slow growth.

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“…In this event, it is virtually impossible to obtain tumor-free resection margins even after hepatoduodenal ligamentectomy, major hepatectomy with en bloc resection of the hepatic artery, portal vein and pancreas head, especially in terms of dissecting margins. In patients with replaced left hepatic artery arising from the left gastric artery, hepatic arterial reconstruction is unnecessary for hepatoduodenal ligamentectomy, and the success of R0 resection may be further assured by preserving the replaced arterial blood supply [71].…”

Section: Hepatic Arterymentioning

confidence: 99%

Assessing resectability in cholangiocarcinoma

et al. 2013

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Assessment of surgical resectability in cholangiocarcinoma is more complicated than other gastrointestinal malignancies and remains unestablished. According to the primary origin and tumor extent, the applied surgical procedure varies from extrahepatic bile duct resection to right or left trisectionectomy concomitant with pancreatoduodenectomy. Portal vein resection and reconstruction during hepatectomy has been feasible. Thanks to the availability of new microscopic surgical techniques, hepatic arterial resection and reconstruction have also come to be applied for locally advanced cholangiocarcinoma cases. These vascular surgical techniques can expand surgical indications for advanced cholangiocarcinoma. On the other hand, determination of the tumor extent or staging still remains difficult and imprecise. The endoscopic approach has come to play significant roles both for preoperative biliary drainage and tumor staging. Estimation of the functional reserve of future remnant liver in cholestatic patients still remains unresolved. Hepatobiliary surgeons should carefully estimate the safety of the surgical procedure in each individual patient requiring extensive hepatobiliary resection. Early establishment of the measurement methods of the functional capacity of future remnant liver is an important and urgent issue for assessing safer surgical resectablity of cholangiocarcinoma.

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Modified hepatoduodenal ligamentectomy for advanced carcinoma of the biliary tract: The importance of preservation of the replaced left hepatic artery

Cited by 7 publications

References 4 publications

Surgical treatment of hilar cholangiocarcinoma in the new era: the Asan experience

Surgical treatment of hilar cholangiocarcinoma in the new era: the Asan experience

Organometric parameters of hepatoduodenal ligament n the perinatal period

Assessing resectability in cholangiocarcinoma

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