title: [En bloc resection of the hepatoduodenal ligament for advanced carcinoma of the biliary tract].
abstract: Theoretically, en bloc resection of the hepatoduodenal ligament is considered to be the most radical procedure for advanced carcinoma of the biliary tract. However, this procedure involves perioperative difficulties such as hepatic ischemia, portal congestion, patency of reconstructed vessels, and high incidence of operative mortality, moreover, when it is combined with resection of the liver and/or pancreas. We developed several tactics in vascular reconstruction, hepatic resection, and pancreatoduodenectomy in order to decrease the operative morbidity and mortality. We preferred to anastomose the portal vein and hepatic artery separately to avoid total hepatic ischemia, and used the porto-systemic bypass during prolonged portal reconstruction. We resected the liver without vascular clamping to minimize hepatic ischemia, and employed the simplified method of pancreatojejunostomy. To date, we performed 4 hepatoligamentectomies and 4 hepatoligament-pancreatoduodenectomies with no operative mortality, although long-term survivors were not encountered. This procedure should be evaluated with more clinical experiences after its safety and indication was established.
authors.affiliation: Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Shimazu
authors.forename: G
authors.initials: G
authors.lastname: Wakabayashi
authors.forename: M
authors.initials: M
authors.lastname: Tanabe
authors.forename: S
authors.initials: S
authors.lastname: Kawachi
authors.forename: S
authors.initials: S
authors.lastname: Takahashi
authors.forename: M
authors.initials: M
authors.lastname: Kitajima
mesh_terms: D000368:Aged; D001661:Biliary Tract Neoplasms / Q000601:surgery*; D004386:Duodenum / Q000601:surgery; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008022:Ligaments / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000379:methods; D010193:Pancreaticojejunostomy / Q000379:methods