Extensive hilar bile duct resection using a transhepatic approach for patients with hepatic hilar bile duct diseases.
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.
Miyazaki
Masaru
M
Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan. masaru@faculty.chiba-u.jp
Kimura
Fumio
F
Shimizu
Hiroaki
H
Yoshidome
Hiroyuki
H
Otsuka
Masayuki
M
Kato
Atsushi
A
Hideyuki
Yoshitomi
Y
Nozawa
Satoshi
S
Furukawa
Katsunori
K
Mituhashi
Noboru
N
Takeuchi
Dan
D
Suda
Kousuke
K
Takano
Shigetsugu
S
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