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

Abstract

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. 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. 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. 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.