title: Aggressive Hemihepatectomy Combined with Resection and Reconstruction of Middle Hepatic Vein for Intrahepatic Cholangiocarcinoma.
abstract: BACKGROUND
  Major hepatectomy for intrahepatic cholangiocarcinoma (ICC) sometimes involves resection of major hepatic veins, which might result in the future liver remnant (FLR) congestion. The necessity and efficacy of resection and reconstruction of the middle hepatic vein (MHV) during right or left hemihepatectomy for resection of ICC remains unclear.
  
  
  METHODS
  Between 1995 and 2013, 68 patients underwent right (n = 24) or left hemihepatectomy (n = 44) for primary ICC, with (n = 27) or without (n = 41) resection of MHV. If the noncongested FLR volume was <40 % of the total liver volume, reconstruction of major hepatic veins was considered.
  
  
  RESULTS
  No significant differences between the groups were observed for patients with or without resection of MHV in the pathologic findings, including negative surgical margins (81 vs. 85 %, P = 0.67) and overall survival (5-year survival rate: 18.3 vs. 33.4 %, P = 0.26). In five patients who underwent venous resection and reconstruction, the noncongested FLR increased from 37 to 74 % after reconstruction (P < 0.01); this noncongested FLR was almost similar to the patients without venous resection (72 %). Three patients undergoing venous resection without reconstruction developed postoperative hepatic failure (grade A in 2 and grade B in 1; International study group of liver surgery definition); however, there was no surgical mortality.
  
  
  CONCLUSIONS
  Aggressive hemihepatectomy for ICC with venous resection in the FLR resulted in acceptable long-term outcome with no mortality when considering hepatic venous reconstruction based on our criterion.
authors.affiliation: Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Akinori
authors.initials: A
authors.lastname: Miyata
authors.affiliation: Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sakamoto
authors.affiliation: Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamamoto
authors.affiliation: Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Nobuhisa
authors.initials: N
authors.lastname: Akamatsu
authors.affiliation: Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Arita
authors.affiliation: Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Kaneko
authors.affiliation: Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Hasegawa
authors.affiliation: Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. KOKUDO-2SU@h.u-tokyo.ac.jp.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kokudo