Left hemihepatectomy and caudate lobectomy and complete extrahepatic bile duct resection using transduodenal approach for hilar cholangiocarcinoma arsing from biliary papillomatosis.
BACKGROUND
Biliary papillomatosis (BP) is a rare disease characterized by multiple papillary lesions of variable distribution and extent in the intra and extrahepatic bile duct. Hepatopancreatoduodenectomy (HPD) can be indicated for the resection of diffuse intra and extrahepatic BP that extended to the distal bile duct and ampullary region. The mortality rate for HPD has recently decreased but HPD still has a high morbidity rate. In this study, we present a safe procedure for concomitant intrahepatic and extrahepatic BP.


METHODS
Preoperative studies showed showed multiple, variable-sized, and nodular papillary masses with mucin in the left intrahepatic ducts, confluence of the right and left hepatic ducts, common hepatic duct, and whole CBD, but peripheral to the right intrahepatic bile ducts were grossly well preserved. We underwent Lt. hepatectomy and the common bile duct and ampulla of Vater were completely resected with transduodenal approach and the pancreatic duct was repositioned to the duodenal mucosa.


CONCLUSIONS
Major hepatic resection and transduodenal approach for complete bile duct resection and pancreatic duct repositioning could be an acceptable therapeutic option for concomitant intrahepatic and extrahepatic biliary papillomatosis without the evidence of pancreatic duct involvement in the patients with severe comorbidity.
Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Jae Keun
JK
Kim
Ho Kyoung
HK
Hwang
Joon Seong
JS
Park
Sin Il
SI
Cho
Dong Sup
DS
Yoon
Hoon Sang
HS
Chi
D000368:Aged; D001650:Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D017734:Bile Ducts, Extrahepatic / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000601:surgery; D001661:Biliary Tract Neoplasms / Q000473:pathology* / Q000601:surgery; D018281:Cholangiocarcinoma / Q000473:pathology / Q000601:surgery*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008297:Male; D010183:Pancreatic Ducts / Q000601:surgery; D010212:Papilloma / Q000473:pathology* / Q000601:surgery