The international surgical journal with global reach

This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS

Role of anatomical right hepatic trisectionectomy for perihilar cholangiocarcinoma. BJS 2014; 101: 261-268.

Published: 8th January 2014

Authors: N. Matsumoto, T. Ebata, Y. Yokoyama, T. Igami, G. Sugawara, Y. Shimoyama et al.

Background

Right‐sided hepatectomy is often selected for perihilar cholangiocarcinoma because the extrahepatic portion of the left hepatic duct is longer than that of the right hepatic duct. However, the length of resected left hepatic duct in right‐sided hepatectomy has not been reported.

Method

Patients who underwent right‐sided hepatectomy for perihilar cholangiocarcinoma were reviewed retrospectively. Trisectionectomies were performed according to a previously reported technique of anatomical right hepatic trisectionectomy. Right hepatectomy was performed according to standard operative procedures. The length of resected left hepatic duct was measured.

Results

Thirty‐three patients underwent right trisectionectomy and 141 had a right hemihepatectomy. Patients having a trisectionectomy had more advanced tumours and so required combined portal vein resection more frequently. Duration of surgery and blood loss were similar in the two groups. Morbidity and mortality rates tended to be higher following hemihepatectomy than after trisectionectomy. The mean(s.d.) length of resected left hepatic duct was significantly greater in trisectionectomy than in hemihepatectomy (25·0(6·9) versus 14·8(5·3) mm; P < 0·001). In patients with Bismuth type IV tumours, the percentage of negative left hepatic duct margins was significantly higher for trisectionectomy than for hemihepatectomy (89 versus 57 per cent; P = 0·021). Achievement of R0 resection was similar and survival did not differ between the two groups, despite different tumour load.

Conclusion

Compared with right hemihepatectomy, anatomical right hepatic trisectionectomy provides a greater length of resected hepatic duct, leading to a high proportion of negative proximal ductal margins even in patients with Bismuth type IV tumours.

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