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Liver parenchyma transection‐first approach in hemihepatectomy with en bloc caudate lobectomy for hilar cholangiocarcinoma: A safe technique to secure favorable surgical outcomes
Author(s) -
Kawabata Yasunari,
Hayashi Hikota,
Yano Seiji,
Tajima Yoshitsugu
Publication year - 2017
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.24612
Subject(s) - medicine , parenchyma , surgery , liver parenchyma , hepatectomy , blood loss , incidence (geometry) , blood transfusion , resection , pathology , physics , optics
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.