Liver resection for perihilar cholangiocarcinoma – why left is sometimes right

Govil, Sanjay; Bharatan, Anand; Rammohan, Ashwin; Kanagavelu, Rathnavel; Kaliamoorthy, Ilankumaran; Rela, Mohamed

doi:10.1016/j.hpb.2016.05.002

Cited by 23 publications

(18 citation statements)

References 14 publications

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“…Left trisectionectomy is the treatment of choice for patients with Bismuth type 4 hilar cholangiocarcinoma. Although the safety of this procedure has been increasing, the reported incidence of postoperative complications is still high [ 2 – 4 ]. Because the RPHA is the only remaining artery that supplies blood flow to the intrahepatic bile duct after left trisectionectomy, preoperative assessment of RPHA is important.…”

Section: Resultsmentioning

confidence: 99%

Atherosclerosis of the right posterior hepatic artery in a patient with hilar cholangiocarcinoma undergoing left trisectionectomy: a case report of a therapeutic pitfall

et al. 2018

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BackgroundWe experienced a rare case of benign arterial stricture of the right posterior hepatic artery (RPHA) caused by atherosclerosis in a patient with hilar cholangiocarcinoma.Case presentationA 75-year-old man was referred to our hospital for the detailed investigation of serum hepatobiliary enzyme elevation. The patient had a history of hypertension, type 2 diabetes mellitus, and an operative history of coronary artery bypass grafting 10 years before. Endoscopic retrograde cholangiography found strictures of the right and left hepatic ducts with involvement of right anterior and posterior bile ducts. Adenocarcinoma was evident by brush cytology. We diagnosed these findings as hilar cholangiocarcinoma and planned left trisectionectomy including bile duct reconstruction. Although the tumor and RPHA were not adjacent, preoperative multidetector computed tomography revealed a stricture of the RPHA that was 5.6 mm in length. We suspected that atherosclerosis caused the stricture, and we performed digital subtraction angiography and intravascular ultrasonography that showed stricture of the RPHA accompanied by thick plaques in the arterial wall. We placed a bare-metal stent in the RPHA and then performed left trisectionectomy. Since this patient developed bile leakage postoperatively, percutaneous drainage was performed. The bile leakage was successfully controlled, and the patient was discharged 3 months after surgery. Unfortunately, 4 months after hepatectomy, he was re-hospitalized with multiple pyogenic liver abscesses. We performed intensive multimodal treatment for the liver abscesses and stabilized the disease; however, we eventually lost this patient due to liver failure 14 months after surgery.ConclusionTo the best of our knowledge, there is no previous literature on atherosclerosis of the RPHA, which was evident preoperatively in our case. Because arterial complications may lead to critical biliary complications in patients who undergo left trisectionectomy, we first performed prophylactic arterial stent placement. We speculate that existing chronic microscopic injury of the peribiliary plexus might have caused the liver abscesses. We successfully diagnosed atherosclerosis of the RPHA preoperatively. However, further investigation of patients is warranted to determine if left trisectionectomy is contraindicated in these patients.

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Section: Resultsmentioning

confidence: 99%

Atherosclerosis of the right posterior hepatic artery in a patient with hilar cholangiocarcinoma undergoing left trisectionectomy: a case report of a therapeutic pitfall

et al. 2018

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“…Traditionally, right‐sided liver and bile duct resection is favoured as it allows for ‘en‐bloc’ resection of the right hepatic artery, which due to its proximity to the biliary bifurcation, is often invaded by tumour. This procedure further takes advantage of the longer extrahepatic course of the left hepatic duct and portal vein to allow for easier vascular and biliary reconstruction to reduce operative complexity, risk of complication, and micro‐seeding of tumour cells . At the time of surgery, however, it remains difficult to differentiate between tumour spread versus perivascular fibrosis where the tumour has invaded into the right hepatic artery .…”

Section: Discussionmentioning

confidence: 99%

Survival outcomes of hepatic resections in Bismuth‐Corlette type IV cholangiocarcinoma

Tang

Pang

et al. 2019

ANZ Journal of Surgery

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Background Surgical resection for Bismuth‐Corlette type IV (BC‐IV) hilar cholangiocarcinomas, also termed Klatskin tumours are technically challenging and were once considered unresectable tumours. Following advances in hepatobiliary imaging and surgical techniques, emerging evidence suggests that surgical resection is a viable avenue for long‐term survival. We aimed to identify factors affecting survival outcomes of hepatic resections for BC‐IV cholangiocarcinomas. Method A systematic review was performed across multiple databases and several clinical trial registries. Two reviewers independently screened and selected papers that contained survival data on BC‐IV cholangiocarcinoma after hepatic resections. Results Of 13 499 papers from our search result, 21 papers satisfied the inclusion criteria. The median post‐operative survival was 30.8 months. The average 1‐ and 5‐year post‐operative survivals were 61.6 and 33.3%, respectively. Predictors of long‐term survival included achievement of R0 margins, minimisation of operative time and reduction intra‐operative blood loss. Conclusion Our analysis demonstrates improving post‐operative outcomes and survival in surgical resection of BC‐IV cholangiocarcinoma and suggests that radical surgical resection is a valid treatment option for the disease.

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“…This is further supported by our observation that DFS is significantly longer in patients undergoing eLH. Pre-operative PVE of the ipsilateral lobe and contralateral PTBD are strategies known to increase the FLR [1,7,9,14]. CT volumetry may help stratify patients into high-or low-risk categories for PLF, guiding pre-operative optimisation of patients with potentially resectable disease by identifying patients with potentially resectable disease who may benefit from PVE.…”

Section: Discussionmentioning

confidence: 99%

Surgery for Hilar cholangiocarcinoma: the Newcastle upon Tyne Liver Unit experience

et al. 2019

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Liver resection for perihilar cholangiocarcinoma – why left is sometimes right

Cited by 23 publications

References 14 publications

Atherosclerosis of the right posterior hepatic artery in a patient with hilar cholangiocarcinoma undergoing left trisectionectomy: a case report of a therapeutic pitfall

Atherosclerosis of the right posterior hepatic artery in a patient with hilar cholangiocarcinoma undergoing left trisectionectomy: a case report of a therapeutic pitfall

Survival outcomes of hepatic resections in Bismuth‐Corlette type IV cholangiocarcinoma

Surgery for Hilar cholangiocarcinoma: the Newcastle upon Tyne Liver Unit experience

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