Extended Left Hepatic Lobectomy and Caudate Lobectomy Combined with Arterio-Portal Shunting for a Case of Hilar Cholangiocarcinoma with Unsuccessful Right Hepatic Arterial Reconstruction

Abstract

Recently, improvements in techniques and instruments for hepatic resection have made massive hepatectomy safe. Patients with hilar cholangiocarcinoma often require hepatic lobectomy combined with resection of the caudate lobe, as well as resection of the extrahepatic bile duct, to remove cancerous lesions completely.1–3 In cases of left hepatic lobectomy combined with caudate lobectomy, we mobilize the caudate lobe from the left side only. Although sometimes both hepatic lobes are mobilized for complete resection of the caudate lobe, we do not mobilize the right lobe in cases of extended left hepatic lobectomy in order to decrease damage to the remnant liver. This technique is very beneficial for the formation of collateral arterial supply to the right hepatic lobe, as well as for protection against mechanical damage to the right hepatic lobe. In particular, when the right hepatic artery has to be resected and, unfortunately, reconstruction of the artery is unsuccessful in cases of left hepatic lobectomy, collateral arterial flow to the residual right hepatic lobe is very important for a good postoperative prognosis.