Pure laparoscopic radical resection for type IIIa hilar cholangiocarcinoma

Abstract

Background Pure laparoscopic radical resection of hilar cholangiocarcinoma is still a challenging procedure, in which laparoscopic lymphadenectomy, hemihepatectomy with caudate lobectomy, and hepaticojejunostomy were included [1][2][3][4]. Relative report is rare in the world up to now. Hilar cholangiocarcinoma has a poor prognosis, especially when it occurs with lymph node metastasis or vessel invasion [5,6]. We recently had a patient who underwent a pure laparoscopic extended right hepatectomy and lymph node dissection and hepaticojejunostomy for a type IIIa hilar cholangiocarcinoma. Methods The tumor was 20 9 15 9 12 mm in diameter and located in the right bile duct and common hepatic duct. Radiological examination showed that hepatic artery and portal vein was not invaded. After the division and mutilation of the right hepatic artery and the right portal vein, short hepatic veins were divided and cut off with clip and ultrasound knife from the anterior face of the vena cava. Mobilization was performed after the devascularization of the right liver, followed by the transection of liver parenchymal with CUSA and ultrasound knife. Finally, left hepatic bile duct jejunum Roux-en-Y reconstruction was performed.Results This patient underwent successfully with a totally laparoscopic procedure. An extended right hepatectomy (right hemihepatectomy combined with caudate lobectomy) and complete lymph node dissection and hepaticojejunostomy were performed in this operation. The operation time was nearly 590 min, and the intraoperative blood loss was about 300 ml. No obvious complication was observed and the postoperative hospital stay was 11 days. The final diagnosis of the hilar cholangiocarcinoma with no lymph node metastasis was pT2bN0M0 stage II (American Joint Committee on Cancer, AJCC). Conclusions Pure laparoscopic resection for hilar cholangiocarcinoma was proved safe and feasible, which enabled the patient to recover early and have an opportunity to receive chemotherapy as soon as possible. We present a video of the described procedure.

Reasons for open conversion in robotic liver surgery: A systematic review with pooled analysis of more than 1000 patients

“…Indications for minimally invasive liver surgery has historically changed, starting with minor, regulated resections expanding to embrace major and extended hepatic surgery, including ALPPS, posterior segments, hilar tumors, and living‐donor hepatectomy . We can speculate that indications to convert changed as well.…”

The role of minimally invasive hepatectomy for hilar and intrahepatic cholangiocarcinoma: A systematic review of the literature

“…Noncomparative studies are demonstrated in Table , and their pooled analysis has shown that 90% of the patients were submitted to major liver resections (ES, 0.9; 95% CI, 0.68‐1.00/heterogeneity I 2 = 0%; Figure E) . Also, it was obtained pooled estimate sizes of 0.51 for overall morbidity (95% CI, 0.11; 0.89/heterogeneity I 2 27.6%; Figure F) . Only one study, published by Elmoghazy et al had events regarding major complications (three events) or postoperative mortality (two events) among 11 cases reported, and thus, it was opted not to perform meta‐analysis.…”

“…For iCCA, four comparative studies (retrospective cohort studies) and nine noncomparative studies were included for analysis . For pCCA analysis, one comparative study (retrospective cohort) and nine noncomparative studies were included . Two records had data regarding both iCCA and pCCA …”

“…7,[26][27][28][29][30][31][32][33][34][35][36][37] For pCCA analysis, one comparative study (retrospective cohort) and nine noncomparative studies were included. [38][39][40][41][42][43][44][45][46][47][48][49] Two records had data regarding both iCCA and pCCA. 7,50…”

Laparoscopic Left Hepatectomy for Ruptured Hepatocellular Carcinoma Controlled After Transcatheter Arterial Embolization: Case Report and Review of the Literature

“…Furthermore, during this interval, no intrahepatic metastasis or peritoneal dissemination was revealed. LLR has been expanded to include minor resection, major resection, anatomical resection, donor hepatectomy (3), hepatectomy with thrombectomy (9), and radical resection for hilar cholangiocellular carcinoma (10). Moreover, recent studies have revealed the usability and safety of LLR in patients with liver cirrhosis (11) and those undergoing repeat hepatectomy (12).…”