Right trisectionectomy of the liver for intrahepatic cholangiocarcinoma with bile duct invasion in a Jehovah's Witness.
Intrahepatic cholangiocarcinoma (ICC) is well known to have a very poor prognosis. Aggressive surgical strategies in the treatment of ICC, including major hepatectomy, have been reported to afford patients the best chance for significant survival. Recent advancements in surgical techniques concerning live donor liver transplantation have dramatically improved the results of major hepatectomy. However, surgical treatment of biliary malignancy is complex and is known to increase the likelihood of blood transfusion. We describe a Jehovah's Witness patient with ICC and concomitant bile duct invasion who had a successful right trisectionectomy with bile duct resection, lymph node dissection, and Rouxen-Y hepatico-jejunostomy without blood transfusion. A multidisciplinary preparation was crucial in obtaining this positive outcome. Importantly, bloodless liver transection techniques with inflow clamping, meticulous dissection, and hemostasis should be utilized for major hepatectomy in a Jehovah's Witness. The success of this case may alert clinicians to consider a hepatectomy as a possible option in the treatment of ICC in a Jehovah's Witness.
Nishida
Seigo
S
Division of Transplantation, Department of Surgery, Miller School of Medicine, University of Miami/Jackson Memorial Medical Center, 1801 NW 9th Avenue, Suite 514, Miami, Florida 33136, USA.
Madariaga
Juan R
JR
Santiago
Sergio
S
Quintini
Cristiano
C
Palaios
Emmanouil
E
Gyamfi
Anthony
A
Rico
Rafael
R
Hamamura
Keisuke
K
Haider
Hani
H
Moon
Jang I
JI
Levi
David M
DM
Casillas
Victor J
VJ
Bejarano
Pablo A
PA
Tzakis
Andreas G
AG
D000328:Adult; D001650:Bile Duct Neoplasms / Q000175:diagnosis / Q000523:psychology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D001706:Biopsy; D001803:Blood Transfusion / Q000523:psychology; D018281:Cholangiocarcinoma / Q000175:diagnosis / Q000523:psychology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D033221:Jehovah's Witnesses; D008279:Magnetic Resonance Imaging; D009361:Neoplasm Invasiveness; D011300:Preoperative Care / Q000523:psychology*; D014057:Tomography, X-Ray Computed