Reconstruction Of Right Hepatic Artery Research Articles

Left Hepatectomy Combined with Right Hepatic Artery Resection and Reconstruction for Hilar Cholangiocarcinoma

BackgroundHepatectomy combined with hepatic artery reconstruction in the operation for hilar cholangiocarcinoma (Klatskin tumor) is a challenging procedure. We present a video of left hepatectomy combined with right hepatic artery reconstruction for hilar cholangiocarcinoma.Patient and MethodsThe patient was a 60-year-old male who presented with obstructive jaundice. The imaging examination showed that the confluence of left and right hepatic ducts and the wall of common hepatic duct were thickened, the local lumen was narrowed, the intrahepatic bile duct was dilated, and the right hepatic artery was invaded by tumors nearly 2.3 centimeters. Left hepatectomy with total caudate lobectomy, resection with reconstruction of right hepatic artery, hilar lymphadenectomy, and Roux-en-Y hepaticojejunostomy were performed.ResultsThe operation time was 345 min, and the amount of bleeding was about 400 ml. There was no blood transfusion. The pathology showed poorly differentiated adenocarcinoma, with negative margins of common bile duct and right hepatic duct, and negative results of all lymph nodes. The patient’s recovery was uneventful and he was discharged on postoperative day 14. The patient was disease free at 12-month follow-up evaluation.ConclusionsHepatic artery resection and reconstruction procedure is safe and feasible for hilar cholangiocarcinoma in a highly tertiary hepatobiliary center.

Extended Cholecystectomy with Reconstruction of Right Hepatic Artery for Carcinoma Gallbladder: A Case Report

The role of vascular reconstruction in surgical resection of advanced carcinoma gall bladder remains unclear, with scarce available literature. Evaluating the benefit of curable resection against the risk of increased postoperative morbidity remains a fine balancing act. Here, we report a case of a 45-year-old male who presented with obstructive jaundice and significant weight loss over 3 months. CECT showed bilateral IHBRD with patent primary confluence and an enhancing polypoidal mass in the proximal CBD of size 11 x 12 mm, in continuity with asymmetric mural thickening of GB neck. Fat planes with vascular structures were seen to be preserved. Possibilities of carcinoma gall bladder or cholangiocarcinoma were considered. Patient underwent ERCP and stenting of the right ductal system for resolution of jaundice. Extended cholecystectomy with extrahepatic bile duct resection and Roux-En-Y hepaticojejunostomy was performed. Intraoperatively, right hepatic artery was found involved with tumor; therefore, a 1 cm segment of the artery was resected and end to end anastomosis was done. Finally, a diagnosis of adenocarcinoma of gallbladder with positive liver resection margin (R1 resection) was made on histopathological examination. The resected right hepatic artery margins, however, were found to be free of tumor. Post-operative course remained uneventful, with no vascular complications. Patient received adjuvant chemoradiotherapy. He remains symptom free at 10 months post-surgery. Our case highlights that right hepatic artery reconstruction can be done in advanced carcinoma gallbladder with low surgical risk and that it remains a viable option for achieving curative resection.

Right hepatic artery reconstruction in laparoscopic cholecystectomy: report of two cases

回顾分析常州市第一人民医院肝胆胰外科2017年9月至2018年3月2例腹腔镜下右肝动脉(RHA)横断后重建患者资料。女性患者术中因胆囊管入胆总管处解剖不清，将过度牵引直径较细的肝总管误认为胆囊管横断，将胆总管深面的RHA误认为胆囊动脉横断。男性患者因将胆囊管上方并行的RHA误认为胆囊动脉而未行仔细解剖横断。请示上级医师后，均顺利完成腹腔镜下RHA重建术。

Left Hepatectomy with Combined Resection and Reconstruction of Right Hepatic Artery for Bismuth Type I and II Perihilar Cholangiocarcinoma.

Right hepatectomy with caudate lobectomy (RHx) is considered an appropriate procedure for Bismuth type I/II perihilar cholangiocarcinoma in terms of its anatomical and oncological aspect. However, validity of left hepatectomy with caudate lobectomy (LHx) concomitant with arterial resection and reconstruction (AR) is not fully evaluated. The patients who underwent surgical resection for Bismuth type I/II perihilar cholangiocarcinoma between 2002 and 2013 were studied. The standard procedure for Bismuth type I/II cholangiocarcinoma in the institute was RHx, while in patients who had insufficient functional reserve of the left liver, LHx was selected, irrespective of the necessity of AR. The clinicopathologic and perioperative outcomes after LHx + AR were compared with those after RHx. The surgical procedures comprised LHx + AR in 12 and RHx in 24. The left liver volume and left liver functional reserve were significantly lower with LHx + AR than with RHx (left liver volume: 28.0 vs. 33.7%, p = 0.026; estimated indocyanine green clearance of the left liver: 0.036 vs. 0.046, p < 0.001). The rate of surgical morbidity was almost identical between the two procedures. No arterial reconstruction-related complications occurred. The overall 3- and 5-year survival rates and median survival time were 66.7%, 41.7% and 44months for LHx + AR and 70.8%, 49.0% and 57months for RHx (p = 0.640). LHx + AR for Bismuth type I/II perihilar cholangiocarcinoma is considered to be a valid alternative to RHx in patients with an insufficient left liver functional reserve.

Extended Hepatectomy for Intrahepatic Cholangiocellular Carcinoma (ICC)

To evaluate the role of extended hepatectomy in locally advanced intrahepatic cholangiocarcinoma (ICC). ICC is a rare tumor which has to be clearly distinguished from hepatocellular carcinoma and extrahepatic bile duct carcinoma. It is believed that long-term survival can only be achieved by surgical resection. Between April 1998 and March 2003, 50 patients with locally advanced ICC (tumor involvement of more than 4 liver segments) underwent surgical exploration. Data were analyzed with regard to patients' characteristics, intraoperative details, pathologic findings, and outcome measured by tumor recurrence, treatment of recurrence, and survival. Resectability rate was 27 of 50 (54%). There were 19 extended right and 8 extended left hepatectomies. In addition, in 16 patients the following 29 procedures were performed: resection of hilar bifurcation (n = 12), partial resection of diaphragm (n = 6), partial resection of vena cava (n = 4), resection and reinsertion of left liver vein (n = 1), portal vein resection (n = 5), resection and reconstruction of right hepatic artery (n = 1). Complete tumor removal (R0-resection) was achieved in 16 patients. In 11 cases, there was microscopic tumor at the cutting margin (R1-resection). Following resection, the overall 1- and 3-year-survival rates were 69% and 55%. After R1-resection and explorative laparotomy, median survival was 5 and 7 months, respectively. Following R0-resection, the calculated median survival and 1- and 3-year-survival rates are 46 months, 94% and 82% (P = 0.0039; log-rank test). Tumor recurred in 6 of 16 patients, and so far 2 patients died of recurrence 28 and 46 months after operation. R0-resection can provide prolonged survival, even in patients with advanced ICC. In particular in solitary tumors without vascular invasion (UICC stage I, sixth classification) there is a major chance for long-term survival and cure. The poor results after R1-resection and the high operative morbidity do not justify palliative resections but underline the need for an improved preoperative assessment of resectability, as well as an aggressive intraoperative approach, to achieve complete tumor resection.