Arterioportal shunting as an alternative to microvascular reconstruction after hepatic artery resection.
BACKGROUND
Portal vein and hepatic artery resection and reconstruction may be required in radical surgery for biliary cancer. Microvascular reconstruction requires special equipment and training, and may be difficult to accomplish when the arterial stump is small, when there are multiple vessels or when the stump lies deep within the wound. This study examined the feasibility and safety of arterioportal shunting as an alternative to arterial reconstruction.


METHODS
Over 30 months, ten patients with biliary cancer (six bile duct and four gallbladder carcinomas) underwent radical surgery with en bloc resection of the hepatic artery and end-to-side arterioportal reconstruction between the common hepatic or gastroduodenal artery and the portal trunk.


RESULTS
No patient died. Complications included bile leakage in two patients and liver abscess in one. Routine angiography performed 1 month after surgery revealed shunt occlusion in three patients. Once the existence of hepatopetal arterial collaterals had been confirmed in the remaining patients, the shunt was occluded by coil embolization.


CONCLUSIONS
Arterioportal shunting appears to be a safe alternative to microvascular reconstruction after hepatic artery resection. However, the safety of the procedure and its potential to increase the cure rate require further assessment in a larger series with a longer follow-up.
Kondo
S
S
Department of Surgical Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Japan. kondows@med.hokudai.ac.jp
Hirano
S
S
Ambo
Y
Y
Tanaka
E
E
Kubota
T
T
Katoh
H
H
D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D001650:Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005706:Gallbladder Neoplasms / Q000473:pathology / Q000601:surgery*; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery*; D016019:Survival Analysis