Intrahepatic cholangiocarcinoma mimicking a metastatic breast cancer: a case report

Abstract

Introduction: Following the Louisville and Morioka consensus conferences, laparoscopic left lateral sectionectomy (LLS) is the standard of care for patients requiring resection of segments II and III. This study examines whether there remain any indications for the open operation in current practice. Methods: The study population is a consecutive series of patients undergoing liver resection under the care of an individual hepatobiliary surgeon (AKS) in a regionally accredited liver surgery service. 323 consecutive liver resections undertaken during the period January 2009 to October 2017 provide the study population. There was 1 post-operative death (0.3% mortality). Operations where LLS was the major component of the procedure are included. Patients undergoing left lobe metastasectomy as a component of major right-sided resection are excluded. Case selection for surgery was reviewed prior to operation at a liver surgery multidisciplinary tumour board. Results: There were 13 open LLS and 10 laparoscopic LLS. Contemporaneously stated indications for open LLS were: LLS + non-surface metastasectomy 4, LLS as part of synchronous liver and bowel surgery 2, LLS as part of redo liver resection 2, large 5 cm tumour in II or III abutting IV 2 and patient preference 4. The proportion of LLS undertaken laparoscopically was greater in the second four years of this period (P=0.57; Non-significant; Fisher's exact). Conclusions: Although open LLS as a component of other liver resections, redo surgery or synchronous liver/bowel resection remains a safe procedure these should now be regarded as relative indications with progressively more patients being managed laparoscopically.