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Hepatic artery AND perihilar cholangiocarcinoma

Atsushi Nanashima, Naoya Imamura, Masahide Hiyoshi, Koichi Yano, Takeomi Hamada, Teru Chiyotanda, Kenzo Nagatomo, Rouko Hamada, Hiroshi Ito
INTRODUCTION: The present case report demonstrated the successfully radical operation (R0) for the highly advanced cholangiocarcinoma involving hilar hepatic arteries and portal vein, The careful preoperative diagnosis to define the adequate resection area and the expert operation was achieved without postoperative severe complications. PRESENTATION OF CASE: A 55-year-old male was admitted to our hospital with obstructive jaundice, and the perihilar cholangiocarcinoma (PC) was found...
2018: International Journal of Surgery Case Reports
Marcia P Gaspersz, Stefan Buettner, Eva Roos, Jeroen L A van Vugt, Robert J S Coelen, Jaynee Vugts, Jimme K Wiggers, Peter J Allen, Marc G Besselink, Olivier R C Busch, Eric J Belt, Michael I D'Angelica, Ronald P DeMatteo, Jeroen de Jonge, T Peter Kingham, Wojciech G Polak, François E J A Willemssen, Thomas M van Gulik, William R Jarnagin, Jan N M Ijzermans, Bas Groot Koerkamp
BACKGROUND: Patients with resectable perihilar cholangiocarcinoma (PHC) on imaging have a substantial risk of metastatic or locally advanced disease, incomplete (R1) resection, and 90-day mortality. Our aim was to develop a preoperative prognostic model to predict surgical success, defined as a complete (R0) resection without 90-day mortality, in patients with resectable PHC on imaging. STUDY DESIGN: Patients with PHC who underwent exploratory laparotomy in three tertiary referral centers were identified...
September 2018: Journal of Surgical Oncology
J Wang
Perihilar biliary tract tumours include hilar cholangiocarcinoma, gallbladder cancer invading the hepatic hilum and intrahepatic cholangiocarcioma invading the hepatic hilum.The tumours have the special characteristics such as strong invasion capability, the anatomic variant, the pathophysiological complexity, the biological behavior diversity and the difficulty of preoperative evaluation which result in low R0 resection rate, more postoperative complications, more mortality and poor prognosis.The perihilar surgical techniques system aims to set a reasonable and individual operation procedure on the principle of precision surgery by taking the key technique of hilar dissection and exposing, evaluting the hilar anatomy by the means of three-dimensional digital medical image evaluation system, evaluting the relationship between the tumour and hepatic artery and portal vein under the condition of hepatic hilum complete exposure by combining anterograde and retrograde route from intra and extra-hepatic direction to hepatic hilum...
May 1, 2018: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Jimme K Wiggers, Bas Groot Koerkamp, David van Klaveren, Robert J Coelen, C Yung Nio, Peter J Allen, Marc G Besselink, Olivier R Busch, Michael I D'Angelica, Ronald P DeMatteo, T Peter Kingham, Thomas M van Gulik, William R Jarnagin
BACKGROUND: Many patients with resectable perihilar cholangiocarcinoma (PHC) on imaging are diagnosed intraoperatively with occult metastatic or locally advanced disease, precluding a curative-intent resection. This study aimed to develop and validate a preoperative risk score. STUDY DESIGN: Patients with resectable PHC on imaging who underwent operations in 2 high-volume centers (US and Europe) between 2000 and 2015 were included. Multivariable logistic regression analysis was used to develop the risk score...
August 2018: Journal of the American College of Surgeons
Jeroen L A van Vugt, Marcia P Gaspersz, Robert J S Coelen, Jaynee Vugts, Tim A Labeur, Jeroen de Jonge, Wojciech G Polak, Olivier R C Busch, Marc G Besselink, Jan N M IJzermans, Chung Y Nio, Thomas M van Gulik, François E J A Willemssen, Bas Groot Koerkamp
BACKGROUND: Although several classifications of perihilar cholangiocarcinoma (PHC) include vascular involvement, its prognostic value has not been investigated. Our aim was to assess the prognostic value of unilateral and main/bilateral involvement of the portal vein (PV) and hepatic artery (HA) on imaging in patients with PHC. METHODS: All patients with PHC between 2002 and 2014 were included regardless of stage or management. Vascular involvement was defined as apparent tumor contact of at least 180° to the PV or HA on imaging...
January 2018: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
Cai De Lu, Jing Huang, Sheng Dong Wu, Yong Fei Hua, Ammar A Javed, Jiong Zhe Fang, Chun Nian Wang, Sheng Ye
BACKGROUND: "Hilar en bloc resection" using a no-touch technique has been advocated as a standard procedure in right-sided hepatectomies for treatment of perihilar cholangiocarcinoma (PHC). In principle, it has never been reported for left-sided tumors. The aim is to describe the procedures of total hilar en bloc resection with left hemihepatectomy and caudate lobectomy (THER-LH) for advanced PHC and discuss feasibility and clinical significance of this novel technique. METHODS: A retrospective study using a prospectively maintained database was performed to identify eight patients who had received THER-LH for advanced PHC from January 2013 to December 2015...
November 2017: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Gu-Wei Ji, Fei-Peng Zhu, Ke Wang, Yong-Xiang Xia, Chen-Yu Jiao, Zi-Cheng Shao, Xiang-Cheng Li
BACKGROUND: Preoperative evaluation of vasculobiliary anatomy in the umbilical fissure (U-point) is pivotal for perihilar cholangiocarcinoma (PCCA) applied to right-sided hepatectomy. The purpose of our study was to review the vasculobiliary anatomy in the U-point using three-dimensional (3D) reconstruction technique, to investigate the diagnostic ability of 2D scans to evaluate anatomic variations, and to discuss its surgical implications. METHODS: A retrospective study of 159 patients with Bismuth type I, II, and IIIa PCCA, who received surgery at our institution from November 2012 to September 2016, was conducted...
June 15, 2017: Journal of Surgical Research
Jang Han Jung, Hyun Jik Lee, Hee Seung Lee, Jung Hyun Jo, In Rae Cho, Moon Jae Chung, Jeong Youp Park, Seung Woo Park, Si Young Song, Seungmin Bang
AIM: To clarify the role of neoadjuvant concurrent chemoradiotherapy (NACCRT) followed by surgical resection for localized or locally advanced perihilar cholangiocarcinoma (CCA). METHODS: We retrospectively reviewed 57 patients who underwent surgical resection with or without NACCRT for perihilar CCA; 12 patients received NACCRT and 45 patients did not received NACCRT. Patients with locally advanced perihilar CCA requiring NACCRT were defined as follows: (1) a mass involving unilateral branches of the portal vein or hepatic artery with insufficient volume of the anticipated remnant lobe; or (2) an infiltrating mass in the main portal vein that was too long for reconstruction, identified at preoperative staging...
May 14, 2017: World Journal of Gastroenterology: WJG
G W Ji, F P Zhu, X C Li
Hepatobiliary surgery is considered to be technically challenging because of complex intrahepatic and perihilar anatomical structures and variations.Nowadays, three-dimensional imaging technique plays an important role in the time of precise liver surgery.Three-dimensional images depict the spatial location of tumor, and the course, confluence pattern and variation of portal vein, hepatic artery, biliary system and hepatic vein distinctly while showing involved hepatic segments and the relationship with adjacent vessels from omnidirectional view, measuring the length of margin and future remnant liver...
April 1, 2017: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Víctor Molina, Jaime Sampson, Joana Ferrer, Alba Díaz, Juan Ramon Ayuso, Santiago Sánchez-Cabús, Josep Fuster, Juan Carlos García-Valdecasas
OBJECTIVE: The objective of this study was to analyse the safety, feasibility and survival outcomes of our treatment of perihilar cholangiocarcinoma (PHC) since the introduction of more aggressive approaches (en bloc, vascular and extended liver resections) in 2007. PATIENTS AND METHODS: From July 2007 to December 2014, 32 consecutive patients with PHC underwent surgery with curative intent. Surgery with resection and reconstruction of the portal vein bifurcation and right hepatic artery was performed if necessary for a complete removal of the tumour...
February 2017: Langenbeck's Archives of Surgery
Naohisa Kuriyama, Shuji Isaji, Akihiro Tanemura, Yusuke Iizawa, Hiroyuki Kato, Yasuhiro Murata, Yoshinori Azumi, Masashi Kishiwada, Shugo Mizuno, Masanobu Usui, Hiroyuki Sakurai
In the most common surgical procedure for perihilar cholangiocarcinoma, the margin status of the proximal bile duct is determined at the final step. Our procedure, the transhepatic hilar approach, confirms a cancer-negative margin status of the proximal bile duct first. We first performed a partial hepatic parenchymal transection to expose the hilar plate, and then transected the proximal bile duct to confirm margin status. Then, divisions of the hepatic artery and portal vein of the future resected liver are performed, followed by the residual hepatic parenchymal transection...
March 2017: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Chun-Yi Tsai, Nobuyuki Watanabe, Tomoki Ebata, Takashi Mizuno, Yuzuru Kamei, Masato Nagino
BACKGROUND: Curative hepatectomy with bile duct resection is the treatment for perihilar cholangiocarcinoma. A locally advanced tumor necessitates hepatectomy with simultaneous vascular resection, and reconstruction remains an obstacle for surgeons. Studies have focused on the variations of hepatic arteries. Nevertheless, the anatomical alignment of the portal veins, bile ducts, and hepatic arteries are equally critical in surgical planning of curative resection for advanced tumors. We have reported promising outcomes of hepatectomy with simultaneous resection and reconstruction of the hepatic artery...
November 16, 2016: World Journal of Surgical Oncology
Xiaodong Wang, Jungang Hu, Guang Cao, Xu Zhu, Yong Cui, Xinqiang Ji, Xuan Li, Renjie Yang, Hui Chen, Haifeng Xu, Peng Liu, Jian Li, Jie Li, Chunyi Hao, Baocai Xing, Lin Shen
Purpose To evaluate the efficacy and safety of hepatic arterial infusion (HAI) of oxaliplatin and 5-fluorouracil for advanced perihilar cholangiocarcinoma (PCC) in this prospective phase II study. Materials and Methods The protocol was approved by the local ethics committee, and all patients gave informed consent. Patients with nonresectable PCC were included in a prospective, open phase II study investigating HAI through interventionally implanted port catheters. HAI consisted of infusions of oxaliplatin 40 mg/m2 for 2 hours, followed by 5-fluorouracil 800 mg/m2 for 22 hours on days 1-3 every 3-4 weeks...
May 2017: Radiology
Nobuyuki Watanabe, Tomoki Ebata, Yukihiro Yokoyama, Tsuyoshi Igami, Gen Sugawara, Takashi Mizuno, Junpei Yamaguchi, Masato Nagino
BACKGROUND: No authors have reported on the anatomic features of the independent right posterior portal vein variant and its relevance to left hepatic trisectionectomy. The purpose of this study was to review vasculobiliary systems according to portal vein anatomy, to clarify the anatomic features of the right posterior portal vein variant, and to discuss its operative implications for left hepatic trisectionectomy. METHODS: In a radiologic study, the 3-dimensional anatomy of the portal vein, hepatic artery, and bile duct were studied in 200 patients who underwent computed tomography...
February 2017: Surgery
Sanjay Govil, Anand Bharatan, Ashwin Rammohan, Rathnavel Kanagavelu, Ilankumaran Kaliamoorthy, Mettu S Reddy, Mohamed Rela
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...
July 2016: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
Takehiro Noji, Takahiro Tsuchikawa, Keisuke Okamura, Kimitaka Tanaka, Yoshitsugu Nakanishi, Toshimichi Asano, Toru Nakamura, Toshiaki Shichinohe, Satoshi Hirano
BACKGROUND: Whether concomitant hepatic artery resection (HAR) improves the prognosis for advanced perihilar cholangiocarcinoma remains controversial. The aim of the present study was to compare short- and long-term surgical results of HAR versus standard resection (SR) for perihilar cholangiocarcinoma using propensity score matching. METHODS: Among 209 patients with perihilar cholangiocarcinoma patients who underwent resection in our department, 28 patients underwent HAR, and the remaining 181 patients underwent SR...
July 2016: Journal of Hepato-biliary-pancreatic Sciences
Nobuhiro Fujita, Yoshiki Asayama, Akihiro Nishie, Kousei Ishigami, Yasuhiro Ushijima, Yukihisa Takayama, Daisuke Okamoto, Koichiro Moirta, Ken Shirabe, Shinichi Aishima, Huanlin Wang, Yoshinao Oda, Hiroshi Honda
OBJECTIVES: To evaluate the relationship between the enhancement pattern of intrahepatic cholangiocarcinomas (ICCs) in the hepatic arterial phase (HAP) of dynamic hepatic CT and the clinicopathological findings with special reference to the perihilar type and the peripheral type. METHODS: Forty-seven patients with pathologically proven ICCs were enrolled. Based on the enhancement pattern in the HAP, the lesions were classified into three groups: a hypovascular group (n=13), rim-enhancement group (n=18), and hypervascular group (n=16)...
February 2017: European Radiology
Peizhan Chen, Bin Li, Yan Zhu, Wei Chen, Xin Liu, Mian Li, Xiaohua Duan, Bin Yi, Jinghan Wang, Chen Liu, Xiangji Luo, Xiaoguang Li, Jingquan Li, Lijian Liang, Xiaoyu Yin, Hui Wang, Xiaoqing Jiang
As the conventional staging systems have poor prognosis prediction ability for patients with perihilar cholangiocarcinoma (pCCA), we established and validated an effective prognostic nomogram for pCCA patients based on their personal and tumor characteristics. A total of 235 patients who received curative intent resections at the Eastern Hepatobiliary Surgery Hospital from 2000 to 2009 were recruited as the primary training cohort. Age, preoperative CA19-9 levels, portal vein involvement, hepatic artery invasion, lymph node metastases, and surgical treatment outcomes (R0 or R1/2) were independent prognostic factors for pCCA patients in the primary cohort as suggested by the multivariate analyses and these were included in the established nomogram...
June 14, 2016: Oncotarget
Hermien Hartog, Jan N M Ijzermans, Thomas M van Gulik, Bas Groot Koerkamp
Perihilar cholangiocarcinoma presents at the biliary and vascular junction of the hepatic hilum with a tendency to extend longitudinally into segmental bile ducts. Most patients show metastatic or unresectable disease at time of presentation or surgical exploration. In patients eligible for surgical resection, challenges are to achieve negative bile duct margins, adequate liver remnant function, and adequate portal and arterial inflow to the liver remnant. Surgical treatment is characterized by high rates of postoperative morbidity and mortality...
April 2016: Surgical Clinics of North America
Fabian Bartsch, Stefan Heinrich, Hauke Lang
INTRODUCTION: Perihilar cholangiocarcinoma is the most frequent cholangiocarcinoma and poses difficulties in preoperative evaluation. For its therapy, often major hepatic resections as well as resection and reconstruction of the hepatic artery or the portal vein are necessary. In the last decades, great advances were made in both the surgical procedures and the perioperative anesthetic management. In this article, we describe from our point of view which facts represent the limits for curative (R0) resection in perihilar cholangiocarcinoma...
June 2015: Viszeralmedizin
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