title: A new technique of biliary reconstruction after "high hilar resection" of hilar cholangiocarcinoma with tumor extension to secondary and tertiary biliary radicals.
abstract: BACKGROUND
  Radical operation for hilar cholangiocellular carcinoma, including extended hepatic resection, seems to improve prognosis by increasing the surgical curability rate. Nevertheless, high postoperative morbidity and mortality have been reported in patients with obstructive jaundice. We describe the technique of "high hilar resection" and a modification of bilioenteric anastomosis for drainage of the multiple secondary or tertiary biliary radicals.
  
  
  METHODS
  Ten patients with advanced hilar cholangiocellular carcinoma underwent a high hilar resection with complete parenchymal preservation, and the biliary drainage was reconstructed by a sheath-to-enteric hepaticojejunostomy. Because of the technical difficulty caused by anastomosis line in the range of the biliary sheath, a modification was performed by dividing the biliary apertures of segments 5 and 4b.
  
  
  RESULTS
  A high hilar resection was successfully performed, and all patients were discharged from the hospital in good condition. No patient died postoperatively. The proximal resection margin was tumor-free in all patients. One patient died after 29 months of peritoneal carcinomatosis. None of the patients developed local recurrence around the hepaticojejunostomy. The remaining nine patients are alive after a mean follow-up of 28.8 months after surgery without any signs of recurrence.
  
  
  CONCLUSIONS
  In highly selected patients with advanced hilar cholangiocellular carcinoma, a high hilar resection is technically safe and oncologically justifiable. In combination with our new technique of sheath-to-enteric anastomosis, the patients considerably benefit from the preservation of liver parenchyma with low postoperative morbidity and very short in-hospital stay.
authors.affiliation: Organ Transplantation and Research Center, Ege University School of Medicine, Izmir, Turkey. drunalaydin@gmail.com
authors.forename: Unal
authors.initials: U
authors.lastname: Aydin
authors.forename: Suleyman
authors.initials: S
authors.lastname: Yedibela
authors.forename: Pinar
authors.initials: P
authors.lastname: Yazici
authors.forename: Bulent
authors.initials: B
authors.lastname: Aydinli
authors.forename: Murat
authors.initials: M
authors.lastname: Zeytunlu
authors.forename: Murat
authors.initials: M
authors.lastname: Kilic
authors.forename: Ahmet
authors.initials: A
authors.lastname: Coker
mesh_terms: D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y; D001650:Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000473:pathology / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D019651:Plastic Surgery Procedures; D016896:Treatment Outcome