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Aggressive Hemihepatectomy Combined with Resection and Reconstruction of Middle Hepatic Vein for Intrahepatic Cholangiocarcinoma

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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Acknowledgment

The authors acknowledge the significant contributions made by M. Ebihara for analysis of 3D imaging simulation.

Disclosure

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan

    Akinori Miyata MD, Yoshihiro Sakamoto MD, PhD, Satoshi Yamamoto MD, PhD, Nobuhisa Akamatsu MD, PhD, Junichi Arita MD, PhD, Junichi Kaneko MD, PhD, Kiyoshi Hasegawa MD, PhD & Norihiro Kokudo MD, PhD, FACS

Authors
  1. Akinori Miyata MD
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  2. Yoshihiro Sakamoto MD, PhD
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  3. Satoshi Yamamoto MD, PhD
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  4. Nobuhisa Akamatsu MD, PhD
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  5. Junichi Arita MD, PhD
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  6. Junichi Kaneko MD, PhD
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  7. Kiyoshi Hasegawa MD, PhD
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  8. Norihiro Kokudo MD, PhD, FACS
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Corresponding author

Correspondence to Norihiro Kokudo MD, PhD, FACS.

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Miyata, A., Sakamoto, Y., Yamamoto, S. et al. Aggressive Hemihepatectomy Combined with Resection and Reconstruction of Middle Hepatic Vein for Intrahepatic Cholangiocarcinoma. Ann Surg Oncol 23 (Suppl 4), 494–500 (2016). https://doi.org/10.1245/s10434-016-5384-z

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  • DOI: https://doi.org/10.1245/s10434-016-5384-z

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