Aggressive Hemihepatectomy Combined with Resection and Reconstruction of Middle Hepatic Vein for Intrahepatic Cholangiocarcinoma.

Abstract:

BACKGROUND:Major hepatectomy for intrahepatic cholangiocarcinoma (ICC) sometimes involves resection of major hepatic veins, which might result in the future liver remnant (FLR) congestion. The necessity and efficacy of resection and reconstruction of the middle hepatic vein (MHV) during right or left hemihepatectomy for resection of ICC remains unclear. METHODS:Between 1995 and 2013, 68 patients underwent right (n = 24) or left hemihepatectomy (n = 44) for primary ICC, with (n = 27) or without (n = 41) resection of MHV. If the noncongested FLR volume was <40 % of the total liver volume, reconstruction of major hepatic veins was considered. RESULTS:No significant differences between the groups were observed for patients with or without resection of MHV in the pathologic findings, including negative surgical margins (81 vs. 85 %, P = 0.67) and overall survival (5-year survival rate: 18.3 vs. 33.4 %, P = 0.26). In five patients who underwent venous resection and reconstruction, the noncongested FLR increased from 37 to 74 % after reconstruction (P < 0.01); this noncongested FLR was almost similar to the patients without venous resection (72 %). Three patients undergoing venous resection without reconstruction developed postoperative hepatic failure (grade A in 2 and grade B in 1; International study group of liver surgery definition); however, there was no surgical mortality. CONCLUSIONS:Aggressive hemihepatectomy for ICC with venous resection in the FLR resulted in acceptable long-term outcome with no mortality when considering hepatic venous reconstruction based on our criterion.

journal_name

Ann Surg Oncol

authors

Miyata A,Sakamoto Y,Yamamoto S,Akamatsu N,Arita J,Kaneko J,Hasegawa K,Kokudo N

doi

10.1245/s10434-016-5384-z

subject

Has Abstract

pub_date

2016-08-01 00:00:00

pages

494-500

issue

Suppl 4

eissn

1068-9265

issn

1534-4681

pii

10.1245/s10434-016-5384-z

journal_volume

23

pub_type

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