Liver parenchyma transection-first approach in hemihepatectomy with en bloc caudate lobectomy for hilar cholangiocarcinoma: A safe technique to secure favorable surgical outcomes.
BACKGROUND
Although hemihepatectomy with total caudate lobectomy (hemiHx-tc) is essential for the surgical treatment of hilar cholangiocarcinoma, the advantage of an anterior approach for hemiHx-tc has not been fully discussed technically; the significance of an anterior approach without liver mobilization for preventing infectious complications also remains unknown.


METHODS
The liver parenchyma transection-first approach (Hp-first) technique is an early transection of the hepatic parenchyma without mobilization of the liver that utilizes a modified liver-hanging maneuver to avoid damaging the future remnant liver.


RESULTS
Between May 2010 and August 2016, a total of 40 consecutive patients underwent surgery for hilar cholangiocarcinoma. Of these, 19 patients underwent a conventional hemihepatectomy with total caudate lobectomy (cHx), while 21 patients received a Hp-first. The patients in the Hp-first group had significantly less intraoperative blood loss (P < 0.001) and blood transfusion (P < 0.001), a lower incidence of postoperative hyperbilirubinemia (p = 0.023), a lower incidence of liver failure (p = 0.038), a lower hospital death rate (p = 0.042), and a better 2-year disease-free survival rate (p = 0.010) than those in the cHx group.


CONCLUSIONS
The liver parenchyma transection-first approach is the preferred technique for hemiHx-tc in hilar cholangiocarcinoma because it resulted in improved surgical outcomes as compared with the conventional approach.
Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan.
Yasunari
http://orcid.org/0000-0002-3350-530X
Y
Kawabata
Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan.
Hikota
H
Hayashi
Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan.
Seiji
S
Yano
Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan.
Yoshitsugu
Y
Tajima
D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D018285:Klatskin Tumor / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology*; D016896:Treatment Outcome
anterior approach; hepatopancreatoduodenectomy; hilar cholangiocarcinoma; liver-hanging maneuver; major hepatectomy