title: Extensive hilar bile duct resection using a transhepatic approach for patients with hepatic hilar bile duct diseases.
abstract: BACKGROUND
  Extensive hilar bile duct resection beyond the second- or third-order intrahepatic biliary radicals is usually required for patients with hilar cholangiocarcinoma as well as those with benign inflammatory stricture. Most hilar cholangiocarcinoma is resected with combined major hepatectomy to obtain free surgical margins. The purpose of this study was to show the surgical procedure and the usefulness of extensive hilar bile duct resection using a transhepatic approach for patients with hilar bile duct diseases.
  
  
  METHODS
  Five patients with hepatic hilar bile duct disease and who were unfit for major hepatectomy for several reasons underwent extensive hilar bile duct resection by way of a transhepatic approach. Four of the patients had hilar bile duct cancer, including 1 with mucous-producing bile duct cancer of low-grade malignancy and 1 with a postsurgical benign bile duct stricture.
  
  
  RESULTS
  After extensive hilar bile duct resection, bile duct stumps ranged in number from 3 to 7 mm (mean 4.4). Surgical margins at bile duct stump were free of cancer in all 4 cancer patients. The long-term outcomes were as follows: 3 patients are alive at the time of publication, and 2 patients have died.
  
  
  CONCLUSIONS
  A transhepatic approach may be useful when performing extensive hilar bile duct resection bile duct stricture of biliary disease at the hepatic hilus, especially in high-risk patients who are unfit for major hepatectomy as well as in those having benign bile duct stricture and low-grade malignancy.
authors.affiliation: Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan. masaru@faculty.chiba-u.jp
authors.forename: Masaru
authors.initials: M
authors.lastname: Miyazaki
authors.forename: Fumio
authors.initials: F
authors.lastname: Kimura
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shimizu
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yoshidome
authors.forename: Masayuki
authors.initials: M
authors.lastname: Otsuka
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kato
authors.forename: Yoshitomi
authors.initials: Y
authors.lastname: Hideyuki
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nozawa
authors.forename: Katsunori
authors.initials: K
authors.lastname: Furukawa
authors.forename: Noboru
authors.initials: N
authors.lastname: Mituhashi
authors.forename: Dan
authors.initials: D
authors.lastname: Takeuchi
authors.forename: Kousuke
authors.initials: K
authors.lastname: Suda
authors.forename: Shigetsugu
authors.initials: S
authors.lastname: Takano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001649:Bile Duct Diseases / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged