title: Surgical strategy for hilar cholangiocarcinoma of the left-side predominance: current role of left trisectionectomy.
abstract: OBJECTIVE
  To evaluate recent surgical strategy for hilar cholangiocarcinoma (HC) of the left-side predominance.
  
  
  BACKGROUND
  When employing left hemihepatectomy (LH) for HC, vasculobiliary anatomy of the right liver often makes it difficult to achieve a tumor-free margin of the right posterior sectional bile duct (RPSBD). Because left trisectionectomy (LTS) can produce a longer resection margin for the RPSBD, we have expanded the indications for LTS over the last 5 years.
  
  
  METHODS
  Sixty-one consecutive patients underwent left-sided hepatectomy for HC, divided into 2 groups according to the operative periods: period 1 (2001-2007; n = 29) and period 2 (2008-2012; n = 32). Clinicopathological outcomes of the groups were compared. The difference in the length of the resectable RPSBD between LH and LTS was radiologically investigated using multidetector-row computed tomography.
  
  
  RESULTS
  The proportion of LTS increased from 10.3% (3/29) in period 1 to 46.9% (15/32) in period 2. R0 resection rates were also improved in period 2. The most common margin positive site in period 1 was the stump of the proximal bile duct; high rates of positive RPSBD stump were noted after LH. The positive proximal ductal margin ratio decreased significantly in period 2. The difference in the length of resectable RPSBD between LH and LTS was 9.0 ± 1.3 mm. There was no mortality in period 2, even after LTS.
  
  
  CONCLUSIONS
  LTS for HC of the left-side predominance improved R0 resection rates without affecting postoperative mortality. LTS should be aggressively performed in patients with appropriate hepatic function, even if tumors are possibly resectable by LH.
authors: Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-0856, Japan.
authors: Isamu
authors: I
authors: Hosokawa
authors: Hiroaki
authors: H
authors: Shimizu
authors: Hiroyuki
authors: H
authors: Yoshidome
authors: Masayuki
authors: M
authors: Ohtsuka
authors: Atsushi
authors: A
authors: Kato
authors: Hideyuki
authors: H
authors: Yoshitomi
authors: Masaru
authors: M
authors: Miyazaki
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000175:diagnosis / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000175:diagnosis / Q000601:surgery*; D049448:Cholangiopancreatography, Magnetic Resonance; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods / Q000592:standards*; D006801:Humans; D008099:Liver / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D016896:Treatment Outcome