title: Clinical significance of reconstruction of the right hepatic artery for biliary malignancy.
abstract: OBJECTIVE
  The clinical significance of resectional surgery with reconstruction of the right hepatic artery for biliary malignancy remains unclear.
  
  
  METHODS
  Between 1990 and 2004, six patients (5%) with cholangiocarcinoma and five patients (3%) with gallbladder carcinoma with possible involvement of the right hepatic artery underwent resectional surgery with reconstruction of the right-sided hepatic artery. The surgical procedures included extended left hemihepatectomy (n=4), left trisectionectomy (n=1), central bisegmentectomy (n=1), resection of anterior segment and inferior area of segment 4 (n=2), resection of segment 5 and inferior area of segment 4 (n=1), and extrahepatic bile duct resection (n=2). Segmental resection and reconstruction of the right (n=7), anterior (n=1), or posterior (n=3) hepatic artery was performed by end-to-end anastomosis (n=5), using the right gastroepiploic artery (n=4), the gastroduodenal artery (n=1), or an autologous venous graft (n=1).
  
  
  RESULTS
  There was no in-hospital mortality. Histopathological arterial involvement was present in seven patients, and the surgical margin was positive in five patients. The median survival was 23 months in R0 patients (n=6), while it was 13 months in R1 patients (n=5) (p=0.16).
  
  
  CONCLUSIONS
  Reconstruction of the right hepatic artery was safely performed in patients with biliary malignancy. Arterial reconstruction can be indicated when the arterial involvement is the only obstacle to obtain negative surgical margins.
authors.affiliation: Hepatobiliary and Pancreatic Surgery Division, Department of Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan. yosakamo@ncc.go.jp
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Sano
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Shimada
authors.forename: Tomoo
authors.initials: T
authors.lastname: Kosuge
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kimata
authors.forename: Minoru
authors.initials: M
authors.lastname: Sakuraba
authors.forename: Junji
authors.initials: J
authors.lastname: Yamamoto
authors.forename: Hidenori
authors.initials: H
authors.lastname: Ojima
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000601:surgery*; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D005706:Gallbladder Neoplasms / Q000601:surgery*; D006498:Hepatectomy / Q000379:methods; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D015996:Survival Rate; D016896:Treatment Outcome