title: Aggressive hepatectomy for the curative treatment of bilobar involvement of type IV-A bile duct cyst.
abstract: OBJECTIVE
  To analyze the risk and benefit of aggressive hepatectomy for the curative treatment of bilobar bile duct cysts (BDCs) of type IV-A.
  
  
  BACKGROUND
  Conventional surgical treatment of bilobar BDCs of type IV-A is extrahepatic cyst excision, followed by biliodigestive anastomosis. The role of hepatectomy in the treatment of bilobar BDCs remains unclear.
  
  
  METHODS
  Between January 2006 and December 2011, a total of 28 patients with bilobar BDCs who underwent an aggressive hepatectomy were identified from a prospective database. Perioperative and long-term outcomes in these patients were compared with 18 patients with bilobar BDCs who received conventional surgical treatment.
  
  
  RESULTS
  Patient characteristics such as age, sex, and clinical presentation were similar in both groups. Cystic dilatation of bile ducts was curatively resected in all 28 patients undergoing aggressive hepatectomy. Postoperative morbidity (57.1% vs 22.2%, P = 0.020), but not mortality (3.6% vs 0%, P = 1.000), in patients who underwent aggressive hepatectomy was significantly increased when compared with those who received conventional surgical treatment. Clearance rate of intrahepatic stones was significantly higher after aggressive hepatectomy than that after conventional surgical treatment (100.0% vs 45.5%, P < 0.001). Twenty-seven of 28 patients (96.4%), except 1 patient who met in-hospital death, achieved a symptom-free status after aggressive hepatectomy during a mean follow-up of 31 months. In contrast, during a mean follow-up of 37 months, 7 patients (38.9%, 7/18) remained free of biliary symptoms after conventional surgical treatment. The long-term outcomes between aggressive hepatectomy and conventional surgical treatment were significantly different (P < 0.001). In addition, no malignant transformation occurred after aggressive hepatectomy. However, intrahepatic cholangiocarcinoma has developed in the remnant BDC in 2 of 18 patients (11.1%) receiving conventional surgical treatment during follow-up.
  
  
  CONCLUSIONS
  Aggressive hepatectomy, a challenging procedure, provides an efficient treatment option for some selected patients with bilobar BDCs of type IV-A. The role of aggressive hepatectomy in the curative treatment of bilobar BDCs of type IV-A should be paid particular attention in the future.
authors.affiliation: Hospital & Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing, China. dongjh301@163.com
authors.forename: Jia-Hong
authors.initials: JH
authors.lastname: Dong
authors.forename: Shi-Zhong
authors.initials: SZ
authors.lastname: Yang
authors.forename: Hong-Tian
authors.initials: HT
authors.lastname: Xia
authors.forename: Wei-Dong
authors.initials: WD
authors.lastname: Duan
authors.forename: Wen-Bin
authors.initials: WB
authors.lastname: Ji
authors.forename: Wan-Qing
authors.initials: WQ
authors.lastname: Gu
authors.forename: Bin
authors.initials: B
authors.lastname: Liang
authors.forename: Zhi-Qiang
authors.initials: ZQ
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D015529:Choledochal Cyst / Q000175:diagnosis / Q000601:surgery*; D003952:Diagnostic Imaging; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome