title: Pure laparoscopic en bloc left hemihepatectomy and caudate lobe resection in patients with intrahepatic cholangiocarcinoma.
abstract: BACKGROUND
  There is an ongoing debate on whether it is safe to push the boundaries and widen the indications of laparoscopic liver surgery after careful patient selection. We report 2 cases of pure laparoscopic en bloc left hemihepatectomy and caudate lobe resection for intrahepatic cholangiocarcinoma (ICC).
  
  
  METHODS
  The first patient (a 79-year old) had an ICC affecting segments 2, 3, and 4 of the liver with dilatation of segment 1 ducts at preoperative imaging. The second patient (an 81-year old) had an ICC affecting segments 2, 3 with local invasion of segment 1. Both patients underwent pure laparoscopic left hemihepatectomy and caudate lobe resection.
  
  
  RESULTS
  The first patient's operative time was 360 minutes and blood loss was 390 mL. Postoperative hospital stay was 8 days. The definitive histology was as follows: pT1 ICC (25 mm in maximal diameter), with 20 mm free resection margin. The second patient's operative time was 310 minutes and blood loss was 300 mL. Postoperative hospital stay was 4 days. The definitive histology was as follows: T1 ICC (49 mm in maximal diameter) with 10 mm free resection margin. The first patient was disease free 12 months after surgery. The second patient died 11 months after surgery of metastatic disease.
  
  
  CONCLUSIONS
  Pure laparoscopic left hemihepatectomy and caudate lobectomy for ICC may be feasible and safe. This is, however, a very complex procedure requiring extensive experience in laparoscopic liver surgery and careful patient selection to optimize surgical outcome. To our knowledge, this is the first systematic description of a pure laparoscopic en bloc left hemihepatectomy and caudate lobe resection for ICC.
authors.affiliation: Hepatobiliary-Pancreatic and Laparoscopic Surgical Unit, Southampton General Hospital, Southampton University Hospitals NHS Trust, Southampton, United Kingdom. mohammed.abuhilal@suht.swest.nhs.uk
authors.forename: Mohammed
authors.initials: M
authors.lastname: Abu Hilal
authors.forename: Abdallah
authors.initials: A
authors.lastname: Badran
authors.forename: Francesco
authors.initials: F
authors.lastname: Di Fabio
authors.forename: Neil William
authors.initials: NW
authors.lastname: Pearce
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D018281:Cholangiocarcinoma / Q000601:surgery*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D016896:Treatment Outcome