Liver parenchyma transection‐first approach in hemihepatectomy with en bloc caudate lobectomy for hilar cholangiocarcinoma: A safe technique to secure favorable surgical outcomes

Yasunari, Kenichi; Hayashi, Hiroki; Yano, Seiji; Tajima, Yoshitsugu

doi:10.1002/jso.24612

Cited by 12 publications

(10 citation statements)

References 33 publications

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“…In 2017, Kawabata et al[ 98 ] proposed their own surgical technique based on reduced liver manipulation and tumor spread. They described an ab-initio parenchymal transection prior to liver mobilization.…”

Section: Treatmentmentioning

confidence: 99%

Practical review for diagnosis and clinical management of perihilar cholangiocarcinoma

Dondossola

Ghidini

Grossi

et al. 2020

WJG

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Cholangiocarcinoma (CCC) is the most aggressive malignant tumor of the biliary tract. Perihilar CCC (pCCC) is the most common CCC and is burdened by a complicated diagnostic iter and its anatomical location makes surgical approach burden by poor results. Besides its clinical presentation, a multimodal diagnostic approach should be carried on by a tertiary specialized center to avoid miss-diagnosis. Preoperative staging must consider the extent of liver resection to avoid post-surgical hepatic failure. During staging iter, magnetic resonance can obtain satisfactory cholangiographic images, while invasive techniques should be used if bile duct samples are needed. Consistently, to improve diagnostic potential, bile duct drainage is not necessary in jaundice, while it is indicated in refractory cholangitis or when liver hypertrophy is needed. Once resecability criteria are identified, the extent of liver resection is secondary to the longitudinal spread of CCC. While in the past type IV pCCC was not considered resectable, some authors reported good results after their treatment. Conversely, in selected unresectable cases, liver transplantation could be a valuable option. Adjuvant chemotherapy is the standard of care for resected patients, while neoadjuvant approach has growing evidences. If curative resection is not achieved, radiotherapy can be added to chemotherapy. This multistep curative iter must be carried on in specialized centers. Hence, the aim of this review is to highlight the main steps and pitfalls of the diagnostic and therapeutic approach to pCCC with a peculiar attention to type IV pCCC.

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Section: Treatmentmentioning

confidence: 99%

Practical review for diagnosis and clinical management of perihilar cholangiocarcinoma

Dondossola

Ghidini

Grossi

et al. 2020

WJG

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“…This anterior approach was useful when rotation of the right liver lobe was difficult because of the tumor size or tumor infiltration into surrounding structures; it avoided excessive bleeding, tumor rupture, compression of the remnant liver parenchyma, and dissemination of tumor cells into the circulation. 4,5 Similarly, the liver parenchyma transectionfirst approach advocated by Kawabata et al 6 is also an anterior approach. It involves transection of the hepatic parenchyma without mobilization of the liver, using a modified liver-hanging maneuver.…”

Section: Introductionmentioning

confidence: 99%

“… 4 , 5 Similarly, the liver parenchyma transection-first approach advocated by Kawabata et al. 6 is also an anterior approach. It involves transection of the hepatic parenchyma without mobilization of the liver, using a modified liver-hanging maneuver.…”

Section: Introductionmentioning

confidence: 99%

Transhepatic hilar approach for Bismuth types III and IV perihilar cholangiocarcinoma with long-term outcomes

Yang

Chen

et al. 2021

J Int Med Res

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Objective To compare the outcomes of the transhepatic hilar approach and conventional approach for surgical treatment of Bismuth types III and IV perihilar cholangiocarcinoma. Methods We retrospectively reviewed the medical records of 82 patients who underwent surgical resection of Bismuth types III and IV perihilar cholangiocarcinoma from 2008 to 2016. The transhepatic hilar approach and conventional approach was used in 36 (43.9%) and 46 (56.1%) patients, respectively. Postoperative complications and overall survival were compared between the two approaches. Results Similar clinical features were observed between the patients treated by the conventional approach and those treated by the transhepatic hilar approach. The transhepatic hilar approach was associated with less intraoperative bleeding and a lower percentage of Clavien grade 0 to II complications than the conventional approach. However, the transhepatic hilar approach was associated with a higher R0 resection rate and better overall survival. Multivariate analysis showed that using the transhepatic hilar approach, the Memorial Sloan-Kettering Cancer Center classification, and R0 resection were independent risk factors for patient survival. Conclusion The transhepatic hilar approach might be the better choice for surgical resection of Bismuth types III and IV perihilar cholangiocarcinoma because it is associated with lower mortality and improved survival.

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“…Currently, hemihepatectomy‐based approach is generally accepted for surgical resection of advanced PHC (Bismuth‐Corlette type III and IV tumor) . Conventionally, liver transection was advanced 1 cm lateral to the midplane to avoid split injury of the middle hepatic vein (MHV) and subsequent torrential bleeding.…”

Section: Introductionmentioning

confidence: 99%

“…[4][5][6] Currently, hemihepatectomy-based approach is generally accepted for surgical resection of advanced PHC (Bismuth-Corlette type III and IV tumor). [6][7][8] Conventionally, liver transection was advanced 1 cm lateral to the midplane to avoid split injury of the middle hepatic vein (MHV) and subsequent torrential bleeding. An important issue in this conventional approach is that dilated intrahepatic ducts containing infected bile are susceptible to be dissected during parenchymal transection and the retained part of diseased hemi-liver containing dilated intrahepatic bile ducts predispose to intra-abdominal infections.…”

mentioning

confidence: 99%

Short‐ and long‐term outcomes of middle hepatic vein–oriented hepatectomy for advanced perihilar cholangiocarcinoma

Zhang

Wang

Zhang

et al. 2018

Journal of Surgical Oncology

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Liver parenchyma transection‐first approach in hemihepatectomy with en bloc caudate lobectomy for hilar cholangiocarcinoma: A safe technique to secure favorable surgical outcomes

Abstract: The liver parenchyma transection-first approach is the preferred technique for hemiHx-tc in hilar cholangiocarcinoma because it resulted in improved surgical outcomes as compared with the conventional approach.

Cited by 12 publications

References 33 publications

Practical review for diagnosis and clinical management of perihilar cholangiocarcinoma

Practical review for diagnosis and clinical management of perihilar cholangiocarcinoma

Transhepatic hilar approach for Bismuth types III and IV perihilar cholangiocarcinoma with long-term outcomes

Short‐ and long‐term outcomes of middle hepatic vein–oriented hepatectomy for advanced perihilar cholangiocarcinoma

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