論文

国際誌
2021年6月

Liver Transection-First Approach in Hepatopancreatoduodenectomy for Hilar Cholangiocarcinoma: A Safe and Secure Technique for the Early Assessment of Curable Resection and Vascular Reconstruction.

Annals of surgical oncology
  • Takamichi Ishii
  • ,
  • Satoru Seo
  • ,
  • Takashi Ito
  • ,
  • Satoshi Ogiso
  • ,
  • Ken Fukumitsu
  • ,
  • Toshihiko Masui
  • ,
  • Kojiro Taura

28
6
開始ページ
2988
終了ページ
2989
記述言語
英語
掲載種別
研究論文(学術雑誌)
DOI
10.1245/s10434-020-09303-x

BACKGROUND: Hepatopancreatoduodenectomy (HPD) is often indicated in the resection of cholangiocarcinoma but is associated with high mortality.1-3 From a risk-benefit perspective, HPD can be justified only when curative resection is achievable.4-6 METHODS: A liver transection-first approach is a surgical technique in which liver transection precedes pancreatoduodenectomy (PD) and skeletonization of the hepatoduodenal ligament in HPD. This approach enables an early assessment of resectability and curability. RESULTS: A 64-year-old with jaundice had a tumor located mainly in the proximal bile duct, spreading from the confluence of hepatic ducts (dominant in the left hepatic duct) to the intrapancreatic bile duct. The right hepatic artery and portal vein existed in close proximity to the tumor. HPD (left hemi-hepatectomy and subtotal stomach-preserving PD) with vascular resection was performed. After liver transection along the Cantlie line, the right Glissonean pedicle was collectively secured inside the liver. The right hepatic artery, right portal vein, and right hepatic duct (RHD) were isolated, and the feasibility of vascular reconstruction was confirmed. After the RHD was divided and the negative margin was confirmed, we proceeded to perform PD. The portal vein was reconstructed between the right portal vein and the portal vein trunk. The right hepatic artery was anastomosed to the second jejunal artery of the jejunal loop with the right gastroepiploic artery as an interposition graft. CONCLUSION: The liver transection-first technique in HPD facilitates early assessment of curability and resectability as well as a safe and secure manipulation and reconstruction of the hepatic artery and portal vein.

リンク情報
DOI
https://doi.org/10.1245/s10434-020-09303-x
PubMed
https://www.ncbi.nlm.nih.gov/pubmed/33169301
ID情報
  • DOI : 10.1245/s10434-020-09303-x
  • PubMed ID : 33169301

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