title: Isolated caudate lobectomy with pancreatoduodenectomy for a bile duct cancer.
abstract: BACKGROUND
  In patients with distal bile duct cancer involving the hepatic hilus, a major hepatectomy concomitant with pancreatoduodenectomy (HPD) is sometimes ideal to obtain a cancer-free resection margin. However, the surgical invasiveness of HPD is considerable.
  
  
  METHODS
  We present our treatment option for patients with distal bile duct cancer showing mucosal spreading to the hepatic hilum associated with impaired liver function. To minimize resection volume of the liver, an isolated caudate lobectomy (CL) with pancreatoduodenectomy (PD) using an anterior liver splitting approach is presented. Liver transection lines and bile duct resection points correspond complete with our standard right and left hemihepatectomies with CL for perihilar cholangiocarcinoma.
  
  
  RESULTS
  Total operation time was 765 min, and pedicle occlusion time was 124 min, respectively. Although the proximal mucosal cancer extension was identified at both the right and the left hepatic ducts, all resection margins were negative for cancer.
  
  
  CONCLUSIONS
  Isolated CL with PD is an alternative radical treatment option for bile duct cancer patients with impaired liver function.
authors.affiliation: Hepatobiliary and Pancreatic Surgery Division, Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan, tsusano@aichi-cc.jp.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Sano
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Shimizu
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Senda
authors.forename: Koji
authors.initials: K
authors.lastname: Komori
authors.forename: Seiji
authors.initials: S
authors.lastname: Ito
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Abe
authors.forename: Taira
authors.initials: T
authors.lastname: Kinoshita
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nimura
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D001706:Biopsy; D018281:Cholangiocarcinoma / Q000473:pathology / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008297:Male; D061646:Operative Time; D016577:Pancreaticoduodenectomy / Q000379:methods*
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