Surgical and Radiological Studies on the Length of the Hepatic Ducts.

Abstract

Right-sided hepatectomy is often selected for perihilar cholangiocarcinoma, due to the anatomic consideration that "the left hepatic duct is longer than that of the right hepatic duct". However, only one study briefly mentioned the length of the hepatic ducts. Our aim is to investigate whether the consideration is correct. In surgical study, the lengths of the resected bile duct were measured using pictures of the resected specimens in 475 hepatectomized patients with perihilar cholangiocarcinoma. In radiological study, the estimated lengths of the bile duct to be resected were measured using cholangiograms reconstructed from computed tomography images in 61 patients with distal bile duct obstruction. In surgical study, the length of the resected left hepatic duct was 25.1 ± 6.4 mm in right trisectionectomy (n = 37) and 14.9 ± 5.7 mm in right hepatectomy (n = 167). The length of the right hepatic duct was 14.1 ± 5.7 mm in left hepatectomy (n = 149) and 21.3 ± 6.4 mm in left trisectionectomy (n = 122). In radiological study, the lengths of the bile duct corresponding to the surgical study were 34.1 ± 7.8, 22.4 ± 7.1, 20.8 ± 4.8, and 31.6 ± 5.3 mm, respectively. Both studies determined that the lengths of the resected bile ducts were (1) similar between right and left hepatectomies, (2) significantly shorter in right hepatectomy than in left trisectionectomy, and (3) the longest in right trisectionectomy. The aforementioned anatomical assumption is a surgeon's biased view. Based on our observations, a flexible procedure selection is recommended.