Extensive hilar bile duct resection using a transhepatic approach for patients with hepatic hilar bile duct diseases

• Published in: The American journal of surgery Vol. 196; no. 1; pp. 125 - 129
• Main Authors: Miyazaki, Masaru, M.D, Kimura, Fumio, M.D, Shimizu, Hiroaki, M.D, Yoshidome, Hiroyuki, M.D, Otsuka, Masayuki, M.D, Kato, Atsushi, M.D, Hideyuki, Yoshitomi, M.D, Nozawa, Satoshi, M.D, Furukawa, Katsunori, M.D, Mituhashi, Noboru, M.D, Takeuchi, Dan, M.D, Suda, Kousuke, M.D, Takano, Shigetsugu, M.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.2008; Elsevier; Elsevier Limited
• Subjects: Aged; Aged, 80 and over; Benign bile duct stricture; Bile; Bile Duct Diseases - surgery; Bile duct resection; Biliary Tract Surgical Procedures - methods; Biological and medical sciences; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Hilar cholangiocarcinoma; Humans; Liver; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Surgery; Transhepatic approach; Tumors; Veins & arteries; Bile duct resection; Benign bile duct stricture; Hilar cholangiocarcinoma; Transhepatic approach; Human; Biliary tract; Bile duct cancer; Stenosis; Hepatic disease; Surgical resection; Malignant tumor; Biliary tract disease; Hepatobiliary disease; Medicine; Treatment; Surgery; Digestive diseases; Cancer
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2007.04.020

Abstract Background Extensive hilar bile duct resection beyond the second- or third-order intrahepatic biliary radicals is usually required for patients with hilar cholangiocarcinoma as well as those with benign inflammatory stricture. Most hilar cholangiocarcinoma is resected with combined major hepatectomy to obtain free surgical margins. The purpose of this study was to show the surgical procedure and the usefulness of extensive hilar bile duct resection using a transhepatic approach for patients with hilar bile duct diseases. Methods Five patients with hepatic hilar bile duct disease and who were unfit for major hepatectomy for several reasons underwent extensive hilar bile duct resection by way of a transhepatic approach. Four of the patients had hilar bile duct cancer, including 1 with mucous-producing bile duct cancer of low-grade malignancy and 1 with a postsurgical benign bile duct stricture. Results After extensive hilar bile duct resection, bile duct stumps ranged in number from 3 to 7 mm (mean 4.4). Surgical margins at bile duct stump were free of cancer in all 4 cancer patients. The long-term outcomes were as follows: 3 patients are alive at the time of publication, and 2 patients have died. Conclusions A transhepatic approach may be useful when performing extensive hilar bile duct resection bile duct stricture of biliary disease at the hepatic hilus, especially in high-risk patients who are unfit for major hepatectomy as well as in those having benign bile duct stricture and low-grade malignancy.