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Case Reports
. 2014 Dec 7;20(45):17260-4.
doi: 10.3748/wjg.v20.i45.17260.

Resection of a cholangiocarcinoma via laparoscopic hepatopancreato- duodenectomy: a case report

Miao-Zun Zhang  1 , Xiao-Wu Xu  1 , Yi-Ping Mou  1 , Jia-Fei Yan  1 , Yi-Ping Zhu  1 , Ren-Chao Zhang  1 , Yu-Cheng Zhou  1 , Ke Chen  1 , Wei-Wei Jin  1 , Erik Matro  1 , Harsha Ajoodhea  1
Affiliations
Case Reports

Resection of a cholangiocarcinoma via laparoscopic hepatopancreato- duodenectomy: a case report

Miao-Zun Zhang et al. World J Gastroenterol. .

Abstract

Some laterally advanced cholangiocarcinomas behave as ductal spread or local invasion, and hepatopancreatoduodenectomy (HPD) may be performed for R0 resection. To date, there have been no reports of laparoscopic HPD (LHPD) in the English literature. We report the first case of LHPD for the resection of a Bismuth IIIa cholangiocarcinoma invading the duodenum. The patient underwent laparoscopic pancreaticoduodenectomy and right hemihepatectomy. Child's approach was used for the reconstruction. The patient recovered well with bile leakage from the 2(nd) postoperative day and was discharged on the 16(th) postoperative day with a drainage tube in place which was removed 2 wk after discharge. Postoperative pathology revealed a well-differentiated cholangiocarcinoma and the margin of liver parenchyma, pancreas and stomach was negative for metastases. The results suggest that LHPD is a feasible and safe procedure when performed in highly specialized centers and in suitable patients with cholangiocarcinoma.

Keywords: Cholangiocarcinoma; Hemihepatectomy; Hepatopancreatoduodenectomy; Laparoscopic surgery; Pancreaticoduodenectomy.

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Figures

Figure 1
Figure 1
Enhanced computed tomography and magnetic resonance cholangiopancreatography findings related to the tumor. A-C: Computed tomography scan revealed stenosis of the hepatic and upper common bile duct as well as irregular thickening of the common bile duct wall (white arrow); D: Magnetic resonance cholangiopancreatography showed obstruction of the common bile duct (white arrow).
Figure 2
Figure 2
Key surgical steps of laparoscopic hepatopancreatoduodenectomy. A: The duodenum was invaded by the tumor (white arrow); B: The inferior border of the pancreatic neck was dissected and a retropancreatic tunnel was created; C: The operative view after laparoscopic pancreaticoduodenectomy. The white arrow head indicates the opening of the right hepatic duct; arrow indicates the opening of the left hepatic duct; D: Laparoscopic hepatopancreatoduodenectomy was completed.
Figure 3
Figure 3
Resected specimen following laparoscopic pancreaticoduodenectomy.
Figure 4
Figure 4
Bile duct was opened from Vater's ampulla to the proximal duct stump. Arrow head, left hepatic duct; arrow right, hepatic duct; T, the tumor had spread from the hepatic portal to the distal part of common bile duct 1.5 cm from Vater's ampulla.
Figure 5
Figure 5
Specimen of laparoscopic right hemihepatectomy. White arrows show the right anterior segmental duct and the right posterior segmental duct.
See this image and copyright information in PMC

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