Role of three-dimensional imaging in operative planning for hilar cholangiocarcinoma.
BACKGROUND
Complex, highly variable, anatomic relationships in the portal hilum complicate the surgical management at hilar cholangiocarcinoma. Preoperative three-dimensional (3D) imaging to stage the tumor and define anatomy may help in planning for curative resection.


METHODS
Between 2003 and 2006, 20 consecutive patients with hilar cholangiocarcinoma underwent preoperative multidetector row computed tomography (MDCT) cholangiography; 3D images of the portal vein, hepatic artery, and bile ducts were created and viewed simultaneously. Longitudinal tumor extension was evaluated by direct cholangiography and 3D cholangiography, and contiguous spread by 2D computed tomography (CT). Of 20 patients, 15 underwent surgical resection. Liver resection was planned based on 3D imaging that allowed visualization of the relationship between the tumor and the umbilical portion of the left portal vein, or the bifurcation of the anterior and posterior branch of the right portal vein. Preoperative and operative findings were compared.


RESULTS
All patients tolerated 3D CT without serious complication. The accuracy rates of longitudinal tumor extension, using the Bismuth-Corlette classification system, were 85% (11/13) and 87% (13/15) with direct cholangiography and 3D cholangiography, respectively. The sensitivity, specificity, and accuracy rates were 100%, 80%, and 87% for portal invasion and 75%, 91%, and 87% for hepatic arterial invasion. The number of bile duct orifices in the cut end of the hilar plate was estimated correctly in 13 of 15 patients. There were no operative deaths. Potentially curative resection was achieved in 14 of 15 patients.


CONCLUSIONS
3D images provide accurate information about the relationship between hilar cholangiocarcinoma and adjacent vessels. This technique is a powerful new tool for improving the proportion of potentially curative resection.
Endo
Itaru
I
Department of Gastroenterological Surgery, Yokohama City University, Graduate School of Medicine, 3-9 Fukuura Kanazawa-ku, Yokohama, Japan. endoit@med.yokohama-cu.ac.jp
Shimada
Hiroshi
H
Sugita
Mitsutaka
M
Fujii
Yoshiro
Y
Morioka
Daisuke
D
Takeda
Kazuhisa
K
Sugae
Sadatoshi
S
Tanaka
Kuniya
K
Togo
Shinji
S
Bourquain
Holger
H
Peitgen
Heinz O
HO
D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging* / Q000601:surgery; D018281:Cholangiocarcinoma / Q000000981:diagnostic imaging* / Q000601:surgery*; D002758:Cholangiography / Q000379:methods*; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000601:surgery; D011183:Postoperative Complications; D011300:Preoperative Care; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods