An Experience of Laparoscopic Hepatopancreatoduodenectomy in Patient with Perihilar Cholangiocarcinoma

Abstract

Introduction: Surgical resection is the only curative treatment for perihilar cholangiocarcinoma (pCCA). Despite this poor survival rate and high morbidity and mortality, hepatopancreatoduodenectomy (HPD )is routinely performed. With recent progress in diagnostic procedures, surgical techniques and perioperative patient care, many studies have shown increased long-term survival rates following this aggressive procedure. However, to our knowledge, there has been no reported case of perihilar cholangiocarcinoma treated with laparoscopic hepatopancreatoduodenectomy(HPD). We recently had a patient who underwent a pure laparoscopic HPD for a type IV pCCA. Methods: A 53-year-old female who was revealed the dilation of intrahepatic hepatic duct and a mass on the perihilar bile duct by abdominal magnetic resonance imaging (MRI). The patient was diagnosed with perihilar cholangiocarcinoma. The decision was to perform a pure laparoscopic extend right hemihepatectomy with caudate lobetectomy and pancreaticoduodenectomy was performed. Results: Operative time was 660 minutes with 500 mL blood loss and 3.5 U red cell. Histological examination revealed a well differentiated mucinous adenocarcinoma without lymph-node metastasis and a negative margin of liver parenchyma and pancreas. She was recovered from a grade B pancreatic fifistula by conservative therapy and discharged post-operatively on day 20 in good health. Conclusions: Complete laparoscopic HPD for pCCA is a challenging procedure. However, this procedure is safe and feasible in selected patients and when performed by surgeons with expertise in liver surgery and minimally invasive techniques.