Left hemihepatectomy with microsurgical reconstruction of the right-sided hepatic vasculature. A strategy for preserving hepatic function in patients with proximal bile duct cancer.
BACKGROUND
Right hemihepatectomy (RH) for proximal bile duct cancer occasionally results in liver failure. We report the feasibility of left hemihepatectomy (LH) with vascular reconstruction (VR) of the right-sided hilar vessels to preserve hepatic reserve.


METHODS
Among 110 patients with proximal bile duct cancer (PBC) treated between January 1980 and December 1998, 11 patients underwent LH with VR of eight portal veins and nine hepatic arteries, and 14 underwent RH with VR of four portal veins and one hepatic artery. Microsurgical techniques were used in 80% (8/10) of the hepatic arterial reconstructions.


RESULTS
Although operation time was significantly longer in the LH group, hospital mortality, blood loss and incidence of histologically cancer positive margin at the bilioenteric anastomotic site were similar in the two groups. Peak serum liver enzyme concentration was significantly higher in the LH group with longer inflow occlusion time, whereas peak serum total bilirubin concentration was significantly higher in the RH group, which had smaller liver remnant. No liver abscess occurred in any patients who underwent microvascular reconstructions. The cumulative survival of the LH group was worse than that of the RH group, in which the proportion of vascular invasion was lower, but not significantly.


CONCLUSIONS
LH with right-sided microvascular reconstruction is technically possible and a feasible option when RH is likely to result in postoperative liver failure.
Yamanaka
N
N
Meiwa General Hospital, 4-31, Agenaruo-Cho, Nishinomiya, Japan 663-8186. nyamana@meiwa-hospital.com
Yasui
C
C
Yamanaka
J
J
Ando
T
T
Kuroda
N
N
Maeda
S
S
Ito
T
T
Okamoto
E
E
D001650:Bile Duct Neoplasms / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D008099:Liver / Q000502:physiology*; D017093:Liver Failure / Q000517:prevention & control; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D013997:Time Factors