title: Hepatic artery reconstruction first for the treatment of hilar cholangiocarcinoma bismuth type IIIB with contralateral arterial invasion: a novel technical strategy.
abstract: BACKGROUND
  En-bloc liver resection with the extrahepatic bile duct is mandatory to obtain tumour-free surgical margins and better long-term outcomes in hilar cholangiocarcinoma (CC). One of the most important criteria for irresectability is local extensive invasion to major vessels. As hilar CC Bismuth type IIIB often requires a major left hepatic resection, the invasion of the right hepatic artery (RHA) usually contraindicates this procedure.
  
  
  METHODS
  The authors describe a novel technique that allowed an oncological resection in two patients with hilar CC Bismuth type IIIB and contralateral arterial invasion. Arterial reconstruction between the posterior branch of the RHA and the left hepatic artery (LHA) was performed as the first surgical step. Once arterial vascular flow was restored, a left trisectionectomy with caudate lobe resection and portal vein reconstruction was performed.
  
  
  RESULTS
  In both patients an R0 resection was achieved. Both patients made a full recovery and were discharged within 14 days of surgery. Both patients remain free of disease at 18 months.
  
  
  CONCLUSIONS
  This new technique allows a R0 resection to be achieved in patients with Bismuth type IIIB hilar CC with contralateral arterial involvement.
authors.affiliation: Hospital Italiano de Buenos Aires, General Surgical Service, Argentina. eduardo.desantibanes@hospitalitaliano.org.ar
authors.forename: Eduardo
authors.initials: E
authors.lastname: de Santibañes
authors.forename: Victoria
authors.initials: V
authors.lastname: Ardiles
authors.forename: Fernando A
authors.initials: FA
authors.lastname: Alvarez
authors.forename: Juan
authors.initials: J
authors.lastname: Pekolj
authors.forename: Claudio
authors.initials: C
authors.lastname: Brandi
authors.forename: Axel
authors.initials: A
authors.lastname: Beskow
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006499:Hepatic Artery / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D019651:Plastic Surgery Procedures / Q000379:methods*; D019043:Vascular Neoplasms / Q000473:pathology / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000379:methods*