No-touch resection of hilar malignancies with right hepatectomy and routine portal reconstruction.
No-touch resection of hilar malignancies with right hepatectomy and routine portal reconstruction.
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DOI：
10.1007/s00534-009-0093-7
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发表时间：
2009-04
期刊：
影响因子：
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通讯作者：
S. Hirano;S. Kondo;Eiichi Tanaka;T. Shichinohe;T. Tsuchikawa;Kentaro Kato
中科院分区：
文献类型：
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作者：
S. Hirano;S. Kondo;Eiichi Tanaka;T. Shichinohe;T. Tsuchikawa;Kentaro Kato
背景/目的肝门区胆道癌切除术后肿瘤同区复发可能是由于门静脉在肝门区受损伤胆管剥离过程中癌细胞在显微镜下播散所致。这项回顾性研究评估了一种新手术的可行性和安全性，该手术包括右侧肝切除术、尾状叶切除术和胆管切除术，并结合常规门静脉分叉切除术，以实现肝门恶性肿瘤的无接触切除术。方法64例肝门部胆道癌行右侧肝切除术的患者中，25例患者根据术前影像学诊断，采用上述新方法常规切除门静脉分叉。我们比较了常规门静脉重建患者（n= 18）和保留门静脉分叉患者（n= 21）的围手术期结果。结果常规门静脉重建术患者的手术资料与常规门静脉重建术及未行门静脉重建术患者相似。术后无与门静脉重建直接相关的并发症。结论非接触肝门恶性肿瘤联合右肝切除术及常规门静脉重建术是可行和安全的。该技术的肿瘤学影响值得进一步评估。
Background/PurposeLocoregional recurrence following resection of hilar biliary cancers could be caused by the microscopic dissemination of cancer cells during dissection of the portal vein from the involved bile duct at the hilar region. This retrospective study assessed the feasibility and safety of a new procedure consisting of right‐sided hepatectomy, caudate lobectomy, and bile duct resection combined with routine resection of the portal bifurcation to enable no‐touch resection of hilar malignancies.MethodsOf 64 patients who underwent right‐sided hepatectomy for hilar biliary cancer, the portal bifurcation was routinely resected by the above new procedure in 25 patients, based on preoperative imaging diagnoses. Perioperative outcomes were compared with those in patients who underwent conventional portal reconstruction (n= 18) and with those in patients who had preservation of the portal bifurcation (n= 21).ResultsPerioperative data from patients with routine portal reconstruction were similar to those in the patients with conventional portal reconstruction and the patients without portal reconstruction. There were no postoperative complications directly related to portal reconstruction.ConclusionsNo‐touch resection of hilar malignancies with right hepatectomy and the routine use of portal reconstruction was feasible and safe. The oncologic impact of this technique merits further evaluation.