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. 2016 Jul;18(7):575-9.
doi: 10.1016/j.hpb.2016.05.002. Epub 2016 May 26.

Liver resection for perihilar cholangiocarcinoma - why left is sometimes right

Sanjay Govil  1 , Anand Bharatan  1 , Ashwin Rammohan  1 , Rathnavel Kanagavelu  1 , Ilankumaran Kaliamoorthy  1 , Mettu S Reddy  1 , Mohamed Rela  2
Affiliations

Liver resection for perihilar cholangiocarcinoma - why left is sometimes right

Sanjay Govil et al. HPB (Oxford). 2016 Jul.

Abstract

Introduction: Left-sided liver resection (LLR) for perihilar cholangiocarcinoma (PHC) may require right hepatic artery (RHA) resection and reconstruction because of its intimate relationship with the biliary confluence. Consequently right-sided resections (RLR) are preferred for Bismuth-Corlette IIIb tumours, and resections avoided in Bismuth-Corlette IV tumours with left lobar atrophy when the RHA is involved by tumour.

Methods: A retrospective analysis of patients with PHC who presented between December 2009 and June 2015.

Results: Thirty-six patients underwent resection for PHC (23 LLR, 13 RLR). The number of Bismuth-Corlette IV patients undergoing LLR was significantly greater than those undergoing RLR (8/23 vs 0/13, p = 0.032). The need for arterial reconstruction (AR) was significantly greater during LLR than RLR (10/23 vs 0/13, p = 0.006). Postoperative liver dysfunction was greater after RLR (5/13 vs 0/23, p = 0.003), and hospital stay was shorter after LLR (10 vs 15 days, p = 0.013).

Conclusions: Safe AR increases the ability to perform potentially curative LLR for PHC. This improves the resectability rate for PHC, particularly for Bismuth-Corlette Type IV tumours. The larger liver remnant after LLR results in less postoperative liver dysfunction and shorter hospital stay without increased operating time, blood loss or morbidity.

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Figures

Figure 1
Figure 1
Identification of a reconstructable right posterior sectoral artery in Rouviere's sulcus to the right of the tumour is a prerequisite to arterial reconstruction for tumours involving the right hepatic artery. (CHA: Common Hepatic Artery, RHA: Right Hepatic Artery, LHA: Left Hepatic Artery, RPHA: Right Posterior Sectoral Hepatic Artery, MPV: Main Portal Vein, LPV: Left Portal Vein, RPV: Right Portal Vein, RHD: Right Hepatic Artery, LHD: Left Hepatic Artery, CBD: Common Bile Duct)
Figure 2
Figure 2
Completed arterial reconstruction after left hepatectomy
Figure 3
Figure 3
Kaplan Meier survival curves between right-sided and left-sided liver resections for perihilar cholangiocarcinoma
See this image and copyright information in PMC

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