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right trisectionectomy for cholangiocarcinoma

Nobuyuki Watanabe, Tomoki Ebata, Yukihiro Yokoyama, Tsuyoshi Igami, Gen Sugawara, Takashi Mizuno, Junpei Yamaguchi, Masato Nagino
BACKGROUND: No authors have reported on the anatomic features of the independent right posterior portal vein variant and its relevance to left hepatic trisectionectomy. The purpose of this study was to review vasculobiliary systems according to portal vein anatomy, to clarify the anatomic features of the right posterior portal vein variant, and to discuss its operative implications for left hepatic trisectionectomy. METHODS: In a radiologic study, the 3-dimensional anatomy of the portal vein, hepatic artery, and bile duct were studied in 200 patients who underwent computed tomography...
September 27, 2016: Surgery
Masahito Uji, Takashi Mizuno, Tomoki Ebata, Gen Sugawara, Tsuyoshi Igami, Keisuke Uehara, Masato Nagino
Although surgical resection is the only way to cure biliary tract cancer (BTC), most BTCs are unresectable by the time they are diagnosed. Chemotherapy is usually used to treat unresectable BTC, but its impact on survival is small. Here, we report the case of a 70-year-old woman with a locally advanced intrahepatic cholangiocarcinoma that was initially diagnosed as an unresectable liver metastasis from colon cancer that had invaded all of the major hepatic veins. However, the tumor was noticeably reduced after treatment with CAPOX plus bevacizumab, which is an uncommon therapy for BTC...
December 2016: Surgical Case Reports
Tomoaki Hirose, Tsuyoshi Igami, Tomoki Ebata, Yukihiro Yokoyama, Gen Sugawara, Takashi Mizuno, Kensaku Mori, Masahiko Ando, Masato Nagino
BACKGROUND: Right-sided hepatectomy is often selected for perihilar cholangiocarcinoma, due to the anatomic consideration that "the left hepatic duct is longer than that of the right hepatic duct". However, only one study briefly mentioned the length of the hepatic ducts. Our aim is to investigate whether the consideration is correct. METHODS: In surgical study, the lengths of the resected bile duct were measured using pictures of the resected specimens in 475 hepatectomized patients with perihilar cholangiocarcinoma...
December 2015: World Journal of Surgery
Yu Aoki, Takayuki Suzuki, Atsushi Kato, Hiroaki Shimizu, Masayuki Ohtsuka, Hideyuki Yoshitomi, Katsunori Furukawa, Tsukasa Takayashiki, Satoshi Kuboki, Shigetsugu Takano, Daiki Okamura, Daisuke Suzuki, Nozomu Sakai, Shingo Kagawa, Masaru Miyazaki
This case report describes an 83-year-old man with intrahepatic cholangiocarcinoma who was referred by a local hospital. Abdominal computed tomography (CT) showed a large tumor in hepatic segments 4, 5, and 8 involving the right hepatic vein and inferior vena cava, which is normally indicative of an unresectable locally advanced tumor. After systemic chemotherapy with gemcitabine and cisplatin, the observed decrease in the level of tumor marker suggested that the cancer was responding to treatment, while radiological findings showed the main tumor shrunk without the presence of distant metastases...
November 2014: Gan to Kagaku Ryoho. Cancer & Chemotherapy
D Seehofer, P Neuhaus
BACKGROUND: Retrospective analyses have shown a 20-40 % incidence of R1 resection in hilar cholangiocarcinoma, which therefore represents a significant issue to be addressed. METHODS: We have reviewed the literature on the impact of R1 resection in hilar cholangiocarcinomas and on possible surgical options to increase the rate of complete tumour resections. RESULTS: To minimise the rate of R1 resections a preoperative risk assessment concerning the predisposed anatomic locations is required...
August 2016: Zentralblatt Für Chirurgie
Shin-Ichiro Kobayashi, Tsuyoshi Igami, Tomoki Ebata, Yukihiro Yokoyama, Gen Sugawara, Takashi Mizuno, Yuji Nimura, Masato Nagino
Intrahepatic cholangiocarcinoma involving all major hepatic veins was diagnosed in a 62-year-old man. Multidetector-row computed tomography showed a massive tumor occupying segments 2-5, 7, and 8, with invasion of all major hepatic veins, although the inferior right hepatic vein, draining the venous flow of segment 6, was clearly visualized. Therefore, we planned an extended left trisectionectomy, involving resection of segments 1-5, 7, and 8, with extrahepatic bile duct resection and concomitant resection of all major hepatic veins...
August 2015: Surgery Today
Christopher R Shubert, Elizabeth B Habermann, Mark J Truty, Kristine M Thomsen, Michael L Kendrick, David M Nagorney
Outcomes after hepatectomy have been assessed incompletely and have not been stratified by both extent of resection and diagnosis. We hypothesized that operative risk is better assessed by stratifying diagnoses into low- and high-risk categories and extent of resection into major and minor resection categories to more accurately evaluate the outcomes after hepatectomy. ACS-NSQIP was reviewed for 30-day operative mortality and major morbidity after partial hepatectomy (PH), left hepatectomy (LH), right hepatectomy (RH), and trisectionectomy (TS)...
November 2014: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Sanjay Govil, Mettu Srinivas Reddy, Mohamed Rela
BACKGROUND: Resection of perihilar cholangiocarcinoma involves major hepatectomy including caudate lobectomy. It is technically challenging because of the complex, intimate and variable relationship between biliary and vascular structures in the liver hilum. Resectability rates vary from 30 to 80 % and about one third of patients have microscopically involved margins. However, adequately performed resections provide 5-year survival of 30-40 % and are worth pursuing. PURPOSE: Better understanding of anatomy, better imaging, improved surgical techniques and progress in perioperative care of these patients have pushed the limits of resection of these tumours...
August 2014: Langenbeck's Archives of Surgery
Isamu Hosokawa, Hiroaki Shimizu, Hiroyuki Yoshidome, Masayuki Ohtsuka, Atsushi Kato, Hideyuki Yoshitomi, Masaru Miyazaki
OBJECTIVE: To evaluate recent surgical strategy for hilar cholangiocarcinoma (HC) of the left-side predominance. BACKGROUND: When employing left hemihepatectomy (LH) for HC, vasculobiliary anatomy of the right liver often makes it difficult to achieve a tumor-free margin of the right posterior sectional bile duct (RPSBD). Because left trisectionectomy (LTS) can produce a longer resection margin for the RPSBD, we have expanded the indications for LTS over the last 5 years...
June 2014: Annals of Surgery
N Matsumoto, T Ebata, Y Yokoyama, T Igami, G Sugawara, Y Shimoyama, M Nagino
BACKGROUND: Right-sided hepatectomy is often selected for perihilar cholangiocarcinoma because the extrahepatic portion of the left hepatic duct is longer than that of the right hepatic duct. However, the length of resected left hepatic duct in right-sided hepatectomy has not been reported. METHODS: Patients who underwent right-sided hepatectomy for perihilar cholangiocarcinoma were reviewed retrospectively. Trisectionectomies were performed according to a previously reported technique of anatomical right hepatic trisectionectomy...
February 2014: British Journal of Surgery
Jianguo Qiu, Shuting Chen, Prasoon Pankaj, Hong Wu
BACKGROUND: Acute liver failure (ALF) is a severe and highly fatal complication arising after extended hepatobiliary surgery. The aim of this study was to investigate the primary management experience of portal vein arterialization (PVA) as a bridge procedure to reduce the risk of ALF for hilar cholangiocarcinoma (HCCA) after extended hepatectomy. METHOD: Between January 2010 and January 2012, 4 patients with HCCA with possible involvement of the right and/or left hepatic artery underwent resectional surgery with reconstruction of the right or left artery blood flow by arterializations of portal vein...
August 2014: Surgical Innovation
M Esaki, K Shimada, S Nara, Y Kishi, Y Sakamoto, T Kosuge, T Sano
BACKGROUND: Data on outcomes of left hepatic trisectionectomy (LT) for perihilar cholangiocarcinoma are limited. The aim of this study was to clarify short- and long-term outcomes of LT for perihilar cholangiocarcinoma. METHODS: Patients with perihilar cholangiocarcinoma who underwent LT between January 2000 and October 2011 were analysed. Surgical variables, mortality, morbidity (Clavien grade I-V), recurrence sites and survival were compared between subjects who underwent LT, right hemihepatectomy or left hemihepatectomy...
May 2013: British Journal of Surgery
Jun Li, Paolo Girotti, Ingmar Königsrainer, Ruth Ladurner, Alfred Königsrainer, Silvio Nadalin
INTRODUCTION: To induce rapid hepatic hypertrophy and to reduce post-hepatectomy liver failure (PHLF), associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been recently developed for patients with a limited future liver remnant. The aim of this study was to further assess the perioperative risk of this procedure and its specific indications. PATIENTS AND METHODS: The study was performed between November 2010 and April 2012 for patients undergoing right trisectionectomy by the ALPPS approach...
May 2013: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Akifumi Nakagawa, Tsuyoshi Igami, Gen Sugawara, Tomoki Ebata, Yukihiro Yokoyama, Yu Takahashi, Harumitsu Ando, Masato Nagino
A 65-year-old female was diagnosed with intrahepatic cholangiocarcinoma involving the inferior vena cava (IVC). The patient underwent right trisectionectomy and caudate lobectomy with bile duct resection and concomitant resection of the IVC. The IVC was reconstructed using the right external iliac vein. Histologically, the tumor had invaded the IVC. Despite the administration of postoperative prophylactic anticoagulant therapy, IVC thrombosis developed, probably due to the difference in diameter between the IVC and the graft...
November 2013: Surgery Today
Christopher P Neal, Christopher D Mann, Esme Pointen, Angus McGregor, Giuseppe Garcea, Matthew S Metcalfe, David P Berry, Ashley R Dennison
BACKGROUND: Histological abnormalities in the non-tumour-bearing liver (NTBL) may influence outcome following hepatectomy. Effects will be most pertinent following right trisectionectomy but have yet to be specifically examined in this context. This study aimed to investigate the influence of perioperative factors, including NTBL histology, on outcome following right trisectionectomy. METHODS: Pathological review of the NTBL of 103 consecutive patients undergoing right trisectionectomy between January 2003 and December 2009 was performed using established criteria for steatosis, non-alcoholic steatohepatitis (NASH), sinusoidal injury (SI), fibrosis and cholestasis...
November 2012: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Seiji Natsume, Tomoki Ebata, Yukihiro Yokoyama, Tsuyoshi Igami, Gen Sugawara, Yoshie Shimoyama, Masato Nagino
OBJECTIVE: To review our experiences with left-sided hepatectomy for perihilar cholangiocarcinoma, to compare left hepatectomy with left trisectionectomy, and to evaluate the clinical significance of left trisectionectomy from the viewpoint of surgical oncology. BACKGROUND: Only 4 large case series have been reported on left trisectionectomy, with only a few patients diagnosed with perihilar cholangiocarcinoma. Therefore, the oncologic advantage of left trisectionectomy compared with left hepatectomy for perihilar cholangiocarcinoma is still unclear...
April 2012: Annals of Surgery
Eduardo de Santibañes, Victoria Ardiles, Fernando A Alvarez, Juan Pekolj, Claudio Brandi, Axel Beskow
BACKGROUND: En-bloc liver resection with the extrahepatic bile duct is mandatory to obtain tumour-free surgical margins and better long-term outcomes in hilar cholangiocarcinoma (CC). One of the most important criteria for irresectability is local extensive invasion to major vessels. As hilar CC Bismuth type IIIB often requires a major left hepatic resection, the invasion of the right hepatic artery (RHA) usually contraindicates this procedure. METHODS: The authors describe a novel technique that allowed an oncological resection in two patients with hilar CC Bismuth type IIIB and contralateral arterial invasion...
January 2012: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
Katsuhiko Uesaka
PURPOSE: Although left-sided hepatectomy, such as a left hepatectomy or left trisectionectomy with resection of the caudate lobe and extrahepatic bile duct, is used to treat hilar cholangiocarcinoma predominantly involving the left side of the hepatic hilum, it is associated with several difficult technical points. The important points during left-sided hepatectomy are described here. TECHNIQUES: There are anatomical variations of the sectional artery and bile duct...
May 2012: Journal of Hepato-biliary-pancreatic Sciences
Eduardo de Santibañes, Fernando A Alvarez, Victoria Ardiles
BACKGROUND: Postoperative liver failure (PLF) is the most feared and severe complication after extensive liver resections. METHODS: We present an innovative surgical technique that has been employed for the treatment of three patients (two with multiple colorectal liver metastases and one with hilar cholangiocarcinoma) whose livers were previously considered locally unresectable because of an insufficient future liver remnant (FLR). In-situ liver transection with right portal vein ligation was implemented...
January 2012: World Journal of Surgery
Marcel Autran Machado, Fabio F Makdissi, Rodrigo C Surjan
BACKGROUND: The most favorable long-term survival rate for hilar cholangiocarcinoma is achieved by a R0 resection. A surgical concept involving a no-touch technique, with extended right hepatic resections and principle en bloc portal vein resection was described by Neuhaus et al. According to Neuhaus et al., their technique may increase the chance of R0, because the right branch of the portal vein and hepatic artery is in close contact with the tumor and is frequently infiltrated. The left artery runs on the left margin of the hilum and often is free...
April 2012: Annals of Surgical Oncology
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