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Langenbeck's Archives of Surgery
Erschienen in: Langenbeck's Archives of Surgery 8/2013

01.12.2013 | How-I-Do-It article

Isolated caudate lobectomy with pancreatoduodenectomy for a bile duct cancer

verfasst von: Tsuyoshi Sano, Yasuhiro Shimizu, Yoshiki Senda, Koji Komori, Seiji Ito, Tetsuya Abe, Taira Kinoshita, Yuji Nimura

Erschienen in: Langenbeck's Archives of Surgery | Ausgabe 8/2013

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Abstract

Background

In patients with distal bile duct cancer involving the hepatic hilus, a major hepatectomy concomitant with pancreatoduodenectomy (HPD) is sometimes ideal to obtain a cancer-free resection margin. However, the surgical invasiveness of HPD is considerable.

Patients and methods

We present our treatment option for patients with distal bile duct cancer showing mucosal spreading to the hepatic hilum associated with impaired liver function. To minimize resection volume of the liver, an isolated caudate lobectomy (CL) with pancreatoduodenectomy (PD) using an anterior liver splitting approach is presented. Liver transection lines and bile duct resection points correspond complete with our standard right and left hemihepatectomies with CL for perihilar cholangiocarcinoma.

Results

Total operation time was 765 min, and pedicle occlusion time was 124 min, respectively. Although the proximal mucosal cancer extension was identified at both the right and the left hepatic ducts, all resection margins were negative for cancer.

Conclusions

Isolated CL with PD is an alternative radical treatment option for bile duct cancer patients with impaired liver function.
Literatur
1.
Seyama Y, Kubota K, Sano K, Noie T, Takayama T, Kosuge T, Makuuchi M (2003) Long-term outcome of extended hemihepatectomy for hilar bile duct cancer with no mortality and high survival rate. Ann Surg 238:73–83PubMed
2.
Kawasaki S, Imamura H, Kobayashi A, Noike T, Miwa S, Miyagawa S (2003) Results of surgical resection for patients with hilar bile duct cancer: application of extended hepatectomy after biliary drainage and hemihepatic portal vein embolization. Ann Surg 238:84–92PubMed
3.
Kondo S, Hirano S, Ambo Y, Tanaka E, Okushiba S, Morikawa T, Katoh H (2004) Forty consecutive resections of hilar cholangiocarcinoma with no postoperative mortality and no positive ductal margins: results of a prospective study. Ann Surg 240:95–101PubMedCrossRef
4.
Nagino M, Kamiya J, Nishio H, Ebata T, Arai T, Nimura Y (2006) Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer: surgical outcome and long-term follow-up. Ann Surg 243:364–372PubMedCrossRef
5.
Sano T, Shimada K, Sakamoto Y, Yamamoto J, Yamasaki S, Kosuge T (2006) One hundred two consecutive hepatobiliary resections for perihilar cholangiocarcinoma with zero mortality. Ann Surg 244:240–247PubMedCrossRef
6.
Nimura Y, Hayakawa N, Kamiya J, Kondo S, Shionoya S (1990) Hepatic segmentectomy with caudate lobe resection for bile duct carcinoma of the hepatic hilus. World J Surg 14:535–544PubMedCrossRef
7.
Kow AW, Wook CD, Song SC, Kim WS, Kim MJ, Park HJ, Heo JS, Choi SH (2012) Role of caudate lobectomy in type III A and III B hilar cholangiocarcinoma: a15-year experience in a tertiary institution. World J Surg 36:1112–1121PubMedCrossRef
8.
Miyazaki M, Kimura F, Shimizu H, Yoshidome H, Otuka M, Kato A, Yoshitomi H, Furukawa K, Takeuchi D, Takayashiki T, Suda K, Takano S (2010) One hundred seven consecutive surgical resections for hilar cholangiocarcinoma of Bismuth types II, III, IV between 2001 and 2008. J Hepatobiliary Pancreat Sci 17:470–475PubMedCrossRef
9.
Unno M, Katayose Y, Rikiyama T, Yoshida H, Yamamoto K, Morikawa T, Hayashi H, Motoi F, Egawa S (2010) Major hepatectomy for perihilar cholangiocarcinoma. J Hepatobiliary Pancreat Sci 17:463–469PubMedCrossRef
10.
Young AL, Prasad KR, Toogood GJ, Lodge JP (2010) Surgical treatment of hilar cholangiocarcinoma in a new era: comparison among leading Eastern and Western centers, Leeds. J Hepatobiliary Pancreat Sci 17:497–504PubMedCrossRef
11.
Lee SG, Song GW, Hwang S, Ha TY, Moon DB, Jung DH, Kim KH, Ahn CS, Kim MH, Lee SK, Sung KB, Ko GY (2010) Surgical treatment of hilar cholangiocarcinoma in the new era: the Asan experience. J Hepatobiliary Pancreat Sci 17:476–489PubMedCrossRef
12.
Hirano S, Kondo S, Tanaka E, Shichinohe T, Tsuchikawa T, Kato K, Matsumoto J, Kawasaki R (2010) Outcome of surgical treatment of hilar cholangiocarcinoma: a special reference to postoperative morbidity and mortality. J Hepatobiliary Pancreat Sci 17:455–462PubMedCrossRef
13.
Igami T, Nishio H, Ebata T, Yokkoyama Y, Sugawara G, Nimura Y, Nagino M (2010) Surgical treatment of hilar cholangiocarcinoma in the “new era”: the Nagoya University experience. J Hepatobiliary Pancreat Sci 17:449–454PubMedCrossRef
14.
Rocha FG, Matsuo K, Blumgart LH, Jarnagin WR (2010) Hilar cholangiocarcinoma: the Memorial Sloan–Kettering Cancer Center experience. J Hepatobiliary Pancreat Sci 17:490–496PubMedCrossRef
15.
Neuhaus P, Jonas S, Bechstein WO, Lohmann R, Radke C, Kling N, Wex C, Lobeck H, Hintze R (1999) Extended resections for hilar cholangiocarcinoma. Ann Surg 230:808–818PubMedCrossRef
16.
Hemming AW, Reed AI, Fujita S, Foley DP, Howard RJ (2005) Surgical management of hilar cholangiocarcinoma. Ann Surg 241:693–702PubMedCrossRef
17.
Miyazaki M, Ito H, Nakagawa K, Ambiru S, Shimizu H, Okaya T, Shinmura K, Nakajima N (1999) Parenchyma-preserving hepatectomy in the surgical treatment of hilar cholangiocarcinoma. J Am Coll Surg 189:575–583PubMedCrossRef
18.
Yamamoto J, Takayama T, Kosuge T, Yoshida J, Shimada K, Yamasaki S, Hasegawa H (1992) An isolated caudate lobectomy by the transhepatic approach for hepatocellular carcinoma in cirrhotic liver. Surgery 111:699–702PubMed
19.
Takayama T, Tanaka T, Higaki T, Katou K, Teshima Y, Makuuchi M (1994) High dorsal resection of the liver. J Am Coll Surg 179:72–75PubMed
20.
Yamamoto J, Kosuge T, Shimada K, Yamasaki S, Takayama T, Makuuchi M (1999) Anterior transhepatic approach for isolated resection of the caudate lobe of the liver. World J Surg 23:97–101PubMedCrossRef
21.
Miyazaki M, Kimura F, Shimizu H, Yoshidome H, Otsuka M, Kato A, Hideyuki Y, Nozawa S, Furukawa K, Mituhashi N, Takeuchi D, Suda K, Takano S (2008) Extensive hilar bile duct resection using a transhepatic approach for patients with hepatic hilar bile duct diseases. Am J Surg 196:125–129PubMedCrossRef
22.
Nimura Y, Hayakawa N, Kamiya J, Maeda S, Kondo S, Yasui A, Shionoya S (1991) Hepatopancreatoduodenectomy for advanced carcinoma of the biliary tract. Hepatogastroenterology 38:170–175PubMed
23.
Ebata T, Nagino M, Nishio H, Arai T, Nimura Y (2007) Right hepatopancreatoduodenectomy: improvements over 23 years to attain acceptability. J Hepatobiliary Pancreat Surg 14:131–135PubMedCrossRef
24.
Wakai T, Shirai Y, Tsuchiya Y, Nomura T, Akazawa K, Hatakeyama K (2008) Combined major hepatectomy and pancreaticoduodenectomy for locally advanced biliary carcinoma: long-term results. World J Surg 32:1067–1074PubMedCrossRef
25.
Kawakami H, Kuwatani M, Etoh K, Haba S, Yamato H, Shinada K, Nakanishi Y, Tanaka E, Hirano S, Kondo S, Kubota K, Asaka M (2009) Endoscopic retrograde cholangiography versus peroral cholangioscopy to evaluate intraepithelial tumor spread in biliary cancer. Endoscopy 41:959–964PubMedCrossRef
26.
Itoi T, Osanai M, Igarashi Y, Tanaka K, Kida M, Maguchi H, Yasuda K, Okano N, Imaizumi H, Yokoyama T, Itokawa F (2010) Diagnostic peroral video cholangioscopy is an accurate diagnostic tool for patients with bile duct lesions. Clin Gastroenterol Hepatol 8:934–938PubMedCrossRef
27.
Nimura Y (1993) Staging of biliary carcinoma: cholangiography and cholangioscopy. Endoscopy 25:76–80PubMedCrossRef
28.
Miyagawa S, Makuuchi M, Kawasaki S, Kakazu T (1995) Criteria for safe hepatic resection. Am J Surg 169:589–594PubMedCrossRef
29.
Sobin LH, Gospodarowicz M, Wittekind C (2009) International Union Against Cancer (UICC). TNM classification of malignant tumors, 7th edn. Wiley, New York
30.
Shimada H, Endo I, Sugita M, Masunari H, Fujii Y, Tanaka K, Sekido H, Togo S (2003) Is parenchyma-preserving hepatectomy a noble option in the surgical treatment for high-risk patients with hilar bile duct cancer? Langenbecks Arch Surg 388:33–41PubMed
31.
Sano K, Makuuchi M, Miki K, Maema A, Sugawara Y, Imamura H, Matsunami H, Takayama T (2002) Evaluation of hepatic venous congestion: proposed indication criteria for hepatic vein reconstruction. Ann Surg 236:241–247PubMedCrossRef
32.
Bhuiya MR, Nimura Y, Kamiya J, Kondo S, Fukata S, Hayakawa N, Shionoya S (1992) Cinicopathologic studies on perineural invasion of bile duct carcinoma. Ann Surg 215:344–349PubMedCrossRef
33.
Klempnauer J, Ridder GJ, von Wasielewski R, Wermer M, Weimann A, Pichlmayr R (1997) Resectional surgery of hilar cholangiocarcinoma: a multivariate analysis of prognostic factors. J Clin Oncol 15:947–954PubMed
34.
Sakamoto Y, Shimada K, Nara S, Esaki M, Ojima H, Sano T, Yamamoto J, Kosuge T (2010) Surgical management of infrahilar/suprapancreatic cholangiocarcinoma: an analysis of the surgical procedures, surgical margins, and survivals of 77 patients. J Gastrointest Surg 14:335–343PubMedCrossRef
35.
Ojima H, Kanai Y, Iwasaki M, Hiraoka N, Shimada K, Sano T, Sakamoto Y, Esaki M, Kosuge T, Sakamoto M, Hirohashi S (2009) Intraductal carcinoma component as a favorable prognostic factor in biliary tract carcinoma. Cancer Sci 100:62–70PubMedCrossRef
36.
Wakai T, Shirai Y, Moroda T, Yokoyama N, Hatakeyama K (2005) Impact of ductal resection margin status on long-term survival in patients undergoing resection for extrahepatic cholangiocarcinoma. Cancer 103:1210–1216PubMedCrossRef
37.
Ebata T, Yokoyama Y, Igami T, Sugawara G, Takahashi Y, Nimura Y, Nagino M (2012) Hepatopancreatoduodenectomy for cholangiocarcinoma: a single-center review of 85 consecutive patients. Ann Surg 256:297–305PubMedCrossRef
Metadaten
Titel
Isolated caudate lobectomy with pancreatoduodenectomy for a bile duct cancer
verfasst von
Tsuyoshi Sano
Yasuhiro Shimizu
Yoshiki Senda
Koji Komori
Seiji Ito
Tetsuya Abe
Taira Kinoshita
Yuji Nimura
Publikationsdatum
01.12.2013
Verlag
Springer Berlin Heidelberg
Erschienen in
Langenbeck's Archives of Surgery / Ausgabe 8/2013
Print ISSN: 1435-2443
Elektronische ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-013-1110-5

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