Extended right hepatectomy for hilar cholangiocarcinoma with resection of the left hepatic duct prior to hepatic resection

2005 ◽  
Vol 93 (1) ◽  
pp. 72-75 ◽  
Author(s):  
Mitsuo Miyazawa ◽  
Yasuko Toshimitsu ◽  
Takahiro Torii ◽  
Katsuya Okada ◽  
Isamu Koyama
Keyword(s):  
Hepatic Resection ◽  
Hilar Cholangiocarcinoma ◽  
Hepatic Duct ◽  
Right Hepatectomy ◽  
Left Hepatic Duct ◽  
Extended Right Hepatectomy

Extended Right Hepatectomy with Total Caudate Lobe Resection and Biliary Tree Resection for a Large Colorectal Liver Metastasis Involving both the Right and Left Hepatic Lobes and the Umbilical Fissure: A Case Report

2005 ◽  
Vol 71 (5) ◽  
pp. 447-449 ◽  
Author(s):  
Aljamir D. Chedid ◽  
Marcio F. Chedid ◽  
Cleber R.P. Kruel ◽  
FÁbio M. Girardi ◽  
Cleber D.P. Kruel
Keyword(s):  
Colorectal Cancer ◽  
Bile Duct ◽  
Liver Metastasis ◽  
Liver Tumors ◽  
Hepatic Duct ◽  
Early Death ◽  
Caudate Lobe ◽  
Right Hepatectomy ◽  
Left Hepatic Duct ◽  
Extended Right Hepatectomy

Very large right-sided liver tumors may grow up to the base of the umbilical fissure and involve the left hepatic duct and can occasionally reach the bile duct confluence. This kind of involvement has often been considered a contraindication to resection. We report a patient who presented with a large hepatic metastasis from colorectal cancer that reached the umbilical fissure and involved the left hepatic duct just above the bile duct confluence. An extended right hepatectomy including complete resection of caudate lobe was performed. We resected the left and common hepatic ducts, as well as both the entire hepatic and the proximal third of common bile duct. A long jejunal limb Roux-en-Y (45 cm) single-layer left intrahepatic hepaticojejunostomy was constructed. She is still well 14 months postoperatively. To the best of our knowledge, this is the first report of such a procedure employed for the treatment of a liver metastasis from colorectal cancer. Extended right hepatectomy including complete caudate lobe resection can be feasible even when the majority of the extrahepatic biliary system needs to be resected. Our approach probably offers the only chance to prevent early death from liver failure in these patients.

scholarly journals Right extended hepatectomy for hilar cholangiocarcinoma: A case report

2020 ◽  
Vol 9 (3) ◽  
pp. 173-176
Author(s):  
Romi Dahal ◽  
Krishna Mohan Adhikari ◽  
Sumita Pradhan ◽  
Ramesh Singh Bhandari
Keyword(s):  
Portal Vein ◽  
Hilar Cholangiocarcinoma ◽  
Hepatic Duct ◽  
Future Liver Remnant ◽  
Operation Time ◽  
Common Hepatic Duct ◽  
Right Hepatectomy ◽  
Liver Remnant ◽  
Extended Right Hepatectomy ◽  
The Right

Radical resection in a case of hilar cholangiocarcinoma is the only curative option. However resection in a hilar cholangiocarcinoma is a challenging procedure because of the low resectability rate. Only a few cases of hilar cholangiocarcinoma are operable because of the advanced nature of disease at presentation. Furthermore, the extent of surgery makes it a complicated process to attempt. We recently had a patient who underwent an open extended right hepatectomy and hepaticojejunostomy for a type IIIa hilar cholangiocarcinoma. The tumor was 20 mm in diameter and was located between the right hepatic duct and common hepatic duct. Radiological examination showed that the hepatic artery was not involved but the right portal vein was invaded by the tumor. CT volumetry was done and the future liver remnant was only 20% in the jaundiced patient. Preoperative drainage was done with percutaneous transhepatic biliary drainage from the left side. Portal vein embolization was done to augment future liver remnant to 30%. The patient underwent an extended right hepatectomy (right trisectionectomy combined with caudate lobectomy). The operation time was nearly 300 min, and the intraoperative blood loss was about 500 ml. However, in the postoperative period, the patient developed post hepatic liver failure which was managed successfully with conservative treatment. The postoperative hospital stay was 23 days. The final diagnosis was hilar cholangiocarcinoma with no nodal metastasis (pT2bN0M0) stage II (American Joint Committee on Cancer, AJCC).

scholarly journals Management of the left hepatic duct during extended right hepatectomy

HPB ◽  
2002 ◽  
Vol 4 (3) ◽  
pp. 127-129
Author(s):  
Jonathan B. Koea ◽  
Leslie H. Blumgart
Keyword(s):  
Hepatic Duct ◽  
Right Hepatectomy ◽  
Left Hepatic Duct ◽  
Extended Right Hepatectomy

scholarly journals ???Anatomic??? Right Hepatic Trisectionectomy (Extended Right Hepatectomy) With Caudate Lobectomy for Hilar Cholangiocarcinoma

2006 ◽  
Vol 243 (1) ◽  
pp. 28-32 ◽  
Author(s):  
Masato Nagino ◽  
Junichi Kamiya ◽  
Toshiyuki Arai ◽  
Hideki Nishio ◽  
Tomoki Ebata ◽  
...  
Keyword(s):  
Hilar Cholangiocarcinoma ◽  
Right Hepatectomy ◽  
Caudate Lobectomy ◽  
Extended Right Hepatectomy

scholarly journals Hepatic resection using ultrasonic surgical aspirator

2017 ◽  
Vol 9 (2) ◽  
pp. 175-183
Author(s):  
Suvit Sriussadaporn ◽  
Sukanya Sriussadaporn ◽  
Rattaplee Pak-art ◽  
Kritaya Kritayakirana ◽  
Supparerk Prichayudh ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Blood Transfusion ◽  
Hepatic Resection ◽  
Operative Time ◽  
Hepatic Duct ◽  
Surgical Techniques ◽  
Pringle Maneuver ◽  
Parenchymal Transection ◽  
Right Hepatectomy ◽  
Ultrasonic Surgical Aspirator

Abstract Background Hepatic resections conducted for malignant tumors can be difficult because of the need to create cancer-free margins. Objectives To examine the outcome of hepatic resections after the introduction of a Cavitron Ultrasonic Surgical Aspirator (CUSA). Methods A retrospective study of patients who underwent hepatic resection by a single surgeon between April 1999 to March 2013. Results We included 101 patients with 104 hepatectomies. Most hepatic parenchymal transections were performed using a CUSA under intermittent hepatic inflow occlusion (Pringle maneuver). Thirty-five patients underwent a right hepatectomy, 11 a left hepatectomy, 6 a right hepatectomy and segment I resection, 6 a right lobectomy, and 46 underwent segmentectomies, wedge resections, or other types of hepatic resections. Biliary-enteric reconstruction with a Roux-en-Y limb of the jejunum to a hepatic duct of the hepatic remnant was performed in 28 patients. Operative time was 90–720 min (median 300 min, mean 327 ± 149 min). Operative blood transfusion was 0–17 units (median 3 units, mean 3.9 ± 3.6 units). Twenty-one hepatectomies were conducted without blood transfusion. Thirty-four postoperative complications occurred in 30 patients with a 9% reoperation rate. Perioperative mortality was 6%. Age, operative time, operative blood transfusion, reoperation, and complications were significantly associated with mortality. Conclusion Careful preoperative diagnosis and evaluation of patients, faultless surgical techniques, and excellent postoperative care are important to avoid potentially serious postoperative complications and mortality. The CUSA is an effective assisting device during hepatic parenchymal transection with a concomitant Pringle maneuver, apparently reducing operative blood loss.

scholarly journals Hilar Cholangiocarcinoma Diagnosed and Treated Early, in Prejaundice Phase

2014 ◽  
Vol 60 (4) ◽  
pp. 163-166
Author(s):  
M. Denes ◽  
Cristian Borz ◽  
A. Torok ◽  
O. Jimborean ◽  
D. Marian
Keyword(s):  
Surgical Treatment ◽  
Bile Duct ◽  
Magnetic Resonance ◽  
Obstructive Jaundice ◽  
Hilar Cholangiocarcinoma ◽  
Hepatic Duct ◽  
Delayed Diagnosis ◽  
Magnetic Resonance Cholangiography ◽  
Klatskin Tumor ◽  
Left Hepatic Duct

Abstract Hilar cholangiocarcinoma, Klatskin tumor or proximal bile duct cancer, is a tumor growing in the right hepatic duct, left hepatic duct or at their confluence. It is a relatively rare but devastating disease. The tight stricture of the biliary ducts and the development of obstructive jaundice are the main characteristics of the disease. In the early phase, symptoms are nonspecific and jaundice is not present, leading to delayed diagnosis and denying the possibility of curative treatment. We present the case of a 74 years old woman who was referred to us with ambiguous symptomatology and without jaundice. The ultrasound and CT scan showed dilation of the left biliary tree, without increase of the cholestatic enzymes. Magnetic resonance cholangiography depicted a tumor in the left hepatic duct (3X3 cm.) with enlargement of the bile ducts above. The surgical treatment consisted of left hepatectomy and hilar lymph nodes dissection. The pathology findings showed a cholangiocarcinoma with a few hilar nodes involvement. Our approach was potentially curative. Unfortunately these situations are seldom because in the majority of cases the patients have obstructive jaundice at presentation and the tumors are unresectable. We consider that a magnetic resonance cholangiography made when we suspect a bile duct tumor, leads us to an early diagnosis and gives us the possibility of a potential curative surgical treatment.

scholarly journals Laparoscopic extended right hepatectomy with biliary reconstruction for hilar cholangiocarcinoma

HPB ◽  
2016 ◽  
Vol 18 ◽  
pp. e798 ◽  
Author(s):  
S. Nakahira ◽  
Y. Takeda ◽  
Y. Katsura ◽  
T. Irei ◽  
M. Inoue ◽  
...  
Keyword(s):  
Hilar Cholangiocarcinoma ◽  
Biliary Reconstruction ◽  
Right Hepatectomy ◽  
Extended Right Hepatectomy

scholarly journals Severe case of post cholecystectomy vasculobiliary injury successfully treated by right hepatectomy with a jump graft to the remaining left hepatic lobe

2020 ◽  
Vol 2020 (9) ◽  
Author(s):  
Carlo Marino ◽  
Ignacio Obaid ◽  
Gabriela Ochoa ◽  
Nicolás Jarufe ◽  
Jorge A Martínez ◽  
...  
Keyword(s):  
Hepatic Duct ◽  
Open Cholecystectomy ◽  
Severe Case ◽  
Common Hepatic Duct ◽  
Right Hepatectomy ◽  
Left Hepatic Lobe ◽  
Left Hepatic Duct ◽  
Hepatic Lobe ◽  
The Right ◽  
Vasculobiliary Injury

Abstract Vasculobiliary injuries (VBI) caused by cholecystectomies are infrequent but extremely serious. We report a case of a severe VBI successfully treated at our center. A 22-year-old woman underwent an open cholecystectomy as treatment for acute cholecystitis and bile duct stones. She was transferred to our center on postoperative Day 4 because of progressive jaundice and encephalopathy. After a proper investigation, we found an extreme VBI with infarction of the right hepatic lobe associated with complete interruption of the portal vein and proper hepatic artery flows and full section of the common hepatic duct. Right hepatectomy with portal—Rex shunt revascularization of the left hepatic lobe and Roux-en-Y hepaticojejunostomy to the left hepatic duct was done. The patient was discharged on the 60th postoperative day. Discussion: This case shows the successful surgical treatment of a severe cholecystectomy’s VBI, avoiding an emergency liver transplant.

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