TY - JOUR
T1 - Antecedent Bile duct cutting in the glissonean pedicle technique (ABC technique) for extremely advanced perihilar cholangiocarcinoma
AU - Yoshikawa, Junichi
AU - Kato, Yutaro
AU - Sugioka, Atsushi
AU - Uyama, Ichiro
N1 - Publisher Copyright:
© 2020 The Authors
PY - 2020/12
Y1 - 2020/12
N2 - Background: In an increasing number of patients undergoing radical surgery for perihilar cholangiocarcinoma [1–3], the intrahepatic bile duct is conventionally transected after the vessels to be preserved or reconstructed are confirmed [3,4]. In patients with extremely advanced perihilar cholangiocarcinoma having massive vascular involvement, it is sometimes difficult to confirm the vessels for reconstruction because of restricted working space and/or anatomical variants, even after liver parenchymal dissection [4]. When the vessels cannot be confirmed, the tumor is usually unresectable [4]. Methods: We developed a novel technique named “Antecedent Bile duct Cutting in the Glissonean pedicle technique (ABC technique)”, in which we directly cut the bile duct in the Glissonean sheath under 5x loupe until the vessels to be reconstructed are secured. Results: This video demonstrates the case of a 62-year-old man post-gastrectomy with a 47 × 36-mm perihilar cholangiocarcinoma with massive vascular involvement. Trisectionectomy was neither indicated left nor right due to excessively small remnant liver volume estimated even with portal vein embolization; thus, extended left hemihepatectomy with caudate lobectomy was applied using the ABC technique. Using the ABC technique after liver parenchymal dissection enabled us to identify and secure RAHA, RPHA, and RPV in favorable positions, and V5, RPV, RAHA, and RPHA were reconstructed. Finally, hepaticojejunostomy was performed. The operative time and blood transfusion were 1170 min and 1240 ml, respectively. R0 resection was achieved and the postoperative course was uneventful. Conclusion: ABC technique was technically feasible and useful for extremely advanced perihilar cholangiocarcinoma with massive vascular involvement.
AB - Background: In an increasing number of patients undergoing radical surgery for perihilar cholangiocarcinoma [1–3], the intrahepatic bile duct is conventionally transected after the vessels to be preserved or reconstructed are confirmed [3,4]. In patients with extremely advanced perihilar cholangiocarcinoma having massive vascular involvement, it is sometimes difficult to confirm the vessels for reconstruction because of restricted working space and/or anatomical variants, even after liver parenchymal dissection [4]. When the vessels cannot be confirmed, the tumor is usually unresectable [4]. Methods: We developed a novel technique named “Antecedent Bile duct Cutting in the Glissonean pedicle technique (ABC technique)”, in which we directly cut the bile duct in the Glissonean sheath under 5x loupe until the vessels to be reconstructed are secured. Results: This video demonstrates the case of a 62-year-old man post-gastrectomy with a 47 × 36-mm perihilar cholangiocarcinoma with massive vascular involvement. Trisectionectomy was neither indicated left nor right due to excessively small remnant liver volume estimated even with portal vein embolization; thus, extended left hemihepatectomy with caudate lobectomy was applied using the ABC technique. Using the ABC technique after liver parenchymal dissection enabled us to identify and secure RAHA, RPHA, and RPV in favorable positions, and V5, RPV, RAHA, and RPHA were reconstructed. Finally, hepaticojejunostomy was performed. The operative time and blood transfusion were 1170 min and 1240 ml, respectively. R0 resection was achieved and the postoperative course was uneventful. Conclusion: ABC technique was technically feasible and useful for extremely advanced perihilar cholangiocarcinoma with massive vascular involvement.
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U2 - 10.1016/j.suronc.2020.10.005
DO - 10.1016/j.suronc.2020.10.005
M3 - Article
C2 - 33080547
AN - SCOPUS:85092626457
SN - 0960-7404
VL - 35
SP - 468
EP - 469
JO - Surgical oncology
JF - Surgical oncology
ER -