Mo1455 Extended Left Hepatic Trisectionectomy as a Feasible Surgical Procedure for Advanced Perihilar Cholangiocarcinoma

Abstract

Objectives: The aim of this study was to clarify the short and long term outcome of extended left hepatic trisectionectomy (LT) for perihilar cholangiocarcinoma. Methods: Patients with perihilar cholangiocarcinoma who underwent LT between January 2000 and October 2010 for perihilar cholangiocarcinoma were analyzed retrospectively. Operative variables, mortality, morbidity, recurrence sites and survival of three groups were compared among LT, right hemihepatectomy (RH) and left hemihepatectomy (LH). Results: A total 203 patients underwent surgical resection for perihilar cholangiocarcinoma, 22 (11%) of whom underwent LT, 79 (39%) underwent RH, and 84 (41%) underwent LH. No mortality occurred, but 17 patients had morbidity. Operative time and blood loss were 655 ± 142 minutes and 2100 ± 1080 ml, respectively. Blood loss in patients with LT was significantly more than in those with LH (2100ml versus 1300ml; P = 0.017). The incidence of Grade IIIa complication in patients with LT was significant higher than RH and LH (P=0.044 and P=0.014), but Grade IIIb and IV complication did not occur in patients with LT. Overall 5-year survival rate was 40% with median survival of 45.8 years. There was no significant difference in survival in patients between LT and other two procedures. Conclusions: LT for perihilar cholangiocarcinoma is feasible and can provide a comparable prognosis for advanced perihilar cholangiocarcinoma originating from left hepatic duct or segment 4 especially extending to the root of the right anterior portal pedicle or confluence of the anterior and posterior branch of the bile duct. S-1069 SSAT Abstracts Mo1456 Audit of the use of Critical View of Safety and Infundibular Cystic Technique in Cystic Duct Identification in Laparoscopic Cholecystectomy Anokha Oomman, Ashraf M. Rasheed, Karthic Rajaram, Krithika Murugan Introduction: The commonest cause of bile duct injury (BDI) during laparoscopic cholecystectomy (LC) is the confusion of bile duct with cystic duct. Operation notes must include the anatomical rationale by which the cystic duct was conclusively identified. Aim: To examine the quality of documentation and the terms used to describe the method/methods utilised to identify the cystic duct during laparoscopic cholecystectomy. Method: The documentation of the method/s used for cystic duct identification was examined in 322 consecutive nonconverted LCs that were carried out between the months of August 2010 and January 2011. Non-protocolised operation notes were studied and stratified into different groups according to the descriptive terms used. The strata included: 1). No documentation of the method used, 2). Calot's triangle was dissected or demonstrated, 3) Infundibular or infundibulocystic technique used, 4). Critical view of safety (CVS) demonstrated, 5) Intra-operative cholangiogram used, or 6) Other methods. Results: Demonstration of the critical view of safety was documented in (4/310) 1.3% of the cases. Infundibular or infundibulo-cystic technique was used to define the cystic duct in (9/310) 3.4% of the notes. Calot's triangle was mentioned in (255/310) 82.3% of the notes. In (43/310) 13.9% of cases, the cystic artery and duct were mentioned without any reference to critical view of safety, infundibular / infundibulo-cystic technique or Calot's triangle. Conclusion: Written documentation of the method of cystic duct identification in the operation notes during LC is sub-optimal. We, hence recommend standardization of the cholecystectomy operative report, inclusion of a video clip and/ or photo image using digital information and communication in medicine (DICOM) to complement the textual operation notes and move towards structured computerised input that links to the picture archiving and communication system (PACS).