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Erschienen in: European Surgery 1/2018

Open Access 02.01.2018 | original article

Hilar en bloc resection for hilar cholangiocarcinoma in patients with limited liver capacities—preserving parts of liver segment 4

verfasst von: Sven Jonas, MD, Felix Krenzien, MD, Georgi Atanasov, MD, Hans-Michael Hau, MD, Matthias Gawlitza, MD, Michael Moche, MD, Georg Wiltberger, MD, Johann Pratschke, MD, Moritz Schmelzle, MD

Erschienen in: European Surgery | Ausgabe 1/2018

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Summary

Background

A right trisectionectomy with portal vein resection represents the conventional approach for hilar cholangiocarcinoma. Here, we present a technical modification of hilar en bloc resection in order to increase the remnant volume by partially preserving liver segment 4.

Methods

The caudal parenchymal dissection line starts centrally between the left lateral and left medial segments. Cranially, the resection line switches to the right towards Cantlie’s line and turns again upwards perpendicularly. Hence, segment 4a and subtotal segment 4b are partially preserved by this novel technique. The left hepatic duct is dissected at the segmental ramification and reconstruction is performed as a single hepaticojejunostomy. The feasibility of the novel parenchyma-sparing approach for hilar cholangiocarcinoma was proven in a case series and medical records were reviewed retrospectively.

Results

Ten patients (6 male, 4 female) underwent segment 4 partially preserving right trisectionectomy for hilar cholangiocarcinoma. Estimated future liver remnant volume was significantly increased (FLRV 38.3%), when compared to standard right trisectionectomy (FLRV 23.9%; p < 0.01). Three of 10 liver resections were associated with major surgical complications (≥IIIb; n = 3); categorized according to the Dindo–Clavien classification. No patient died due to complications associated with postoperatively impaired liver function. Tumor-free margins could be achieved in 8 patients while median overall survival and disease-free survival were 547 and 367 days, respectively.

Conclusion

This novel parenchyma-sparing modification of hilar en bloc resection by partially preserving segment 4 allows to safely increase the remnant liver volume without neglecting principles of local radicality.
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Literatur
1.
Zurück zum Zitat Nimura Y, Kamiya J, Kondo S, Nagino M, Uesaka K, Oda K, Sano T, Yamamoto H, Hayakawa N. Aggressive preoperative management and extended surgery for hilar cholangiocarcinoma: Nagoya experience. J Hepatobiliary Pancreat Surg. 2000;7:155–62.CrossRef Nimura Y, Kamiya J, Kondo S, Nagino M, Uesaka K, Oda K, Sano T, Yamamoto H, Hayakawa N. Aggressive preoperative management and extended surgery for hilar cholangiocarcinoma: Nagoya experience. J Hepatobiliary Pancreat Surg. 2000;7:155–62.CrossRef
2.
Zurück zum Zitat Jarnagin WR, Fong Y, DeMatteo RP, Gonen M, Burke EC, Bodniewicz BSJ, Youssef BAM, Klimstra D, Blumgart LH. Staging, resectability and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg. 2001;234:507–17.CrossRef Jarnagin WR, Fong Y, DeMatteo RP, Gonen M, Burke EC, Bodniewicz BSJ, Youssef BAM, Klimstra D, Blumgart LH. Staging, resectability and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg. 2001;234:507–17.CrossRef
3.
Zurück zum Zitat Bismuth H, Nakache R, Diamond T. Management strategies in resection for hilar cholangiocarcinoma. Ann Surg. 1992;215:31–8.CrossRef Bismuth H, Nakache R, Diamond T. Management strategies in resection for hilar cholangiocarcinoma. Ann Surg. 1992;215:31–8.CrossRef
4.
Zurück zum Zitat Neuhaus P, Jonas S. Surgery for hilar cholangiocarcinoma – the German experience. J Hepatobiliary Pancreat Surg. 2000;7(2):142–7.CrossRef Neuhaus P, Jonas S. Surgery for hilar cholangiocarcinoma – the German experience. J Hepatobiliary Pancreat Surg. 2000;7(2):142–7.CrossRef
5.
Zurück zum Zitat Jonas S, Bechstein WO, Kling N, Neuhaus P. Extent of resection in surgical therapy of central bile duct carcinomas. Langenbecks Arch Chir Suppl Kongressbd. 1997;114:1075–7.PubMed Jonas S, Bechstein WO, Kling N, Neuhaus P. Extent of resection in surgical therapy of central bile duct carcinomas. Langenbecks Arch Chir Suppl Kongressbd. 1997;114:1075–7.PubMed
6.
Zurück zum Zitat Neuhaus P, Jonas S, Bechstein WO, Lohmann R, Radke C, Kling N, Wex C, Lobeck H, Hintze R. Extended resections for hilar cholangiocarcinoma. Ann Surg. 1999;230(6):808–818.CrossRef Neuhaus P, Jonas S, Bechstein WO, Lohmann R, Radke C, Kling N, Wex C, Lobeck H, Hintze R. Extended resections for hilar cholangiocarcinoma. Ann Surg. 1999;230(6):808–818.CrossRef
7.
Zurück zum Zitat Jonas S, Steinmüller T, Neuhaus P. Surgical therapy of liver hilus tumors. Chirurg. 2001;72(7):775–83.CrossRef Jonas S, Steinmüller T, Neuhaus P. Surgical therapy of liver hilus tumors. Chirurg. 2001;72(7):775–83.CrossRef
8.
Zurück zum Zitat Neuhaus P, Thelen A, Jonas S, Puhl G, Denecke T, Veltzke-Schlieker W, Seehofer D. Oncological superiority of hilar en bloc resection for the treatment of hilar cholangiocarcinoma. Ann Surg Oncol. 2012;19(5):1602–8.CrossRef Neuhaus P, Thelen A, Jonas S, Puhl G, Denecke T, Veltzke-Schlieker W, Seehofer D. Oncological superiority of hilar en bloc resection for the treatment of hilar cholangiocarcinoma. Ann Surg Oncol. 2012;19(5):1602–8.CrossRef
9.
Zurück zum Zitat Aljiffry M, Abdulelah A, Walsh M, Peltekian K, Alwayn I, Molinari M. Evidence-based approach to cholangiocarcinoma: a systematic review of the current literature. J Am Coll Surg. 2009;208:134–47.CrossRef Aljiffry M, Abdulelah A, Walsh M, Peltekian K, Alwayn I, Molinari M. Evidence-based approach to cholangiocarcinoma: a systematic review of the current literature. J Am Coll Surg. 2009;208:134–47.CrossRef
10.
Zurück zum Zitat Sasaki R, Kondo T, Oda T, Murata S, Wakabayashi G, Ohkohchi N. Impact of three-dimensional analysis of multidetector row computed tomography cholangioportography in operative planning for hilar cholangiocarcinoma. Am J Surg. 2011;202:441–8.CrossRef Sasaki R, Kondo T, Oda T, Murata S, Wakabayashi G, Ohkohchi N. Impact of three-dimensional analysis of multidetector row computed tomography cholangioportography in operative planning for hilar cholangiocarcinoma. Am J Surg. 2011;202:441–8.CrossRef
11.
Zurück zum Zitat Edge SB, Byrd DR, Compton CC. AJCC cancer staging manual. 7th ed. New York: Springer; 2010. Edge SB, Byrd DR, Compton CC. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.
12.
Zurück zum Zitat Han IW, Jang JY, Kang MJ, Kwon W, Park JW, Chang YR, Kim SW. Role of resection for Bismuth type IV hilar cholangiocarcinoma and analysis of determining factors for curative resection. Ann Surg Treat Res. 2014;87(2):87–93.CrossRef Han IW, Jang JY, Kang MJ, Kwon W, Park JW, Chang YR, Kim SW. Role of resection for Bismuth type IV hilar cholangiocarcinoma and analysis of determining factors for curative resection. Ann Surg Treat Res. 2014;87(2):87–93.CrossRef
13.
Zurück zum Zitat Vincent JL. Relevance of albumin in modern critical care medicine. Best Pract Res Clin Anaesthesiol. 2009;23(2):183–91.CrossRef Vincent JL. Relevance of albumin in modern critical care medicine. Best Pract Res Clin Anaesthesiol. 2009;23(2):183–91.CrossRef
14.
Zurück zum Zitat Vincent JL, Dubois MJ, Navickis RJ, Wilkes MM. Hypoalbuminemia in acute illness: is there a rationale for intervention? A meta-analysis of cohort studies and controlled trials. Ann Surg. 2003;237(3):319–34.PubMedPubMedCentral Vincent JL, Dubois MJ, Navickis RJ, Wilkes MM. Hypoalbuminemia in acute illness: is there a rationale for intervention? A meta-analysis of cohort studies and controlled trials. Ann Surg. 2003;237(3):319–34.PubMedPubMedCentral
15.
Zurück zum Zitat SAFE Study Investigators, Finfer S, McEvoy S, Bellomo R, Bellomo R, McArthur C, Myburgh J, Norton R. Impact of albumin compared to saline on organ function and mortality of patients with severe sepsis. Intensive Care Med. 2011;37(1):86–96.CrossRef SAFE Study Investigators, Finfer S, McEvoy S, Bellomo R, Bellomo R, McArthur C, Myburgh J, Norton R. Impact of albumin compared to saline on organ function and mortality of patients with severe sepsis. Intensive Care Med. 2011;37(1):86–96.CrossRef
16.
Zurück zum Zitat Jonas S, Benckert C, Thelen A, Lopez-Hänninen E, Rösch T, Neuhaus P. Radical surgery for hilar cholangiocarcinoma. Eur J Surg Oncol. 2008;34(3):263–71.CrossRef Jonas S, Benckert C, Thelen A, Lopez-Hänninen E, Rösch T, Neuhaus P. Radical surgery for hilar cholangiocarcinoma. Eur J Surg Oncol. 2008;34(3):263–71.CrossRef
17.
Zurück zum Zitat Schnitzbauer AA, Lang SA, Goessmann H, et al. Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2‑staged extended right hepatic resection in small-for-size settings. Ann Surg. 2012;255(3):405–14.CrossRef Schnitzbauer AA, Lang SA, Goessmann H, et al. Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2‑staged extended right hepatic resection in small-for-size settings. Ann Surg. 2012;255(3):405–14.CrossRef
18.
Zurück zum Zitat Nadalin S, Capobianco I, Li J, et al. Indications and limits for associating liver partition and portal vein ligation for staged Hepatectomy (ALPPS). Lessons learned from 15 cases at a single centre. Z Gastroenterol. 2014;52:35–42.CrossRef Nadalin S, Capobianco I, Li J, et al. Indications and limits for associating liver partition and portal vein ligation for staged Hepatectomy (ALPPS). Lessons learned from 15 cases at a single centre. Z Gastroenterol. 2014;52:35–42.CrossRef
19.
Zurück zum Zitat Torres OJ, Fernandes ES, Oliveira CV, et al. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): the Brazilian experience. Arq Bras Cir Dig. 2013;26:40:43. Torres OJ, Fernandes ES, Oliveira CV, et al. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): the Brazilian experience. Arq Bras Cir Dig. 2013;26:40:43.
21.
Zurück zum Zitat Schmelzle M, Duhme C, Junger W, Salhanick SD, Chen Y, Wu Y, Toxavidis V, Csizmadia E, Han L, Bian S, Fürst G, Nowak M, Karp SJ, Knoefel WT, Schulte Esch J, Robson SC. CD39 modulates hematopoietic stem cell recruitment and promotes liver regeneration in mice and humans after partial hepatectomy. Ann Surg. 2013;257(4):693–701.CrossRef Schmelzle M, Duhme C, Junger W, Salhanick SD, Chen Y, Wu Y, Toxavidis V, Csizmadia E, Han L, Bian S, Fürst G, Nowak M, Karp SJ, Knoefel WT, Schulte Esch J, Robson SC. CD39 modulates hematopoietic stem cell recruitment and promotes liver regeneration in mice and humans after partial hepatectomy. Ann Surg. 2013;257(4):693–701.CrossRef
22.
Zurück zum Zitat am Esch JS, Schmelzle M, Fürst G, Robson SC, Krieg A, Duhme C, Tustas RY, Alexander A, Klein HM, Topp SA, Bode JG, Häussinger D, Eisenberger CF, Knoefel WT. Infusion of CD133+ bone marrow-derived stem cells after selective portal vein embolization enhances functional hepatic reserves after extended right hepatectomy: a retrospective single-center study. Ann Surg. 2012;255(1):79–85.CrossRef am Esch JS, Schmelzle M, Fürst G, Robson SC, Krieg A, Duhme C, Tustas RY, Alexander A, Klein HM, Topp SA, Bode JG, Häussinger D, Eisenberger CF, Knoefel WT. Infusion of CD133+ bone marrow-derived stem cells after selective portal vein embolization enhances functional hepatic reserves after extended right hepatectomy: a retrospective single-center study. Ann Surg. 2012;255(1):79–85.CrossRef
Metadaten
Titel
Hilar en bloc resection for hilar cholangiocarcinoma in patients with limited liver capacities—preserving parts of liver segment 4
verfasst von
Sven Jonas, MD
Felix Krenzien, MD
Georgi Atanasov, MD
Hans-Michael Hau, MD
Matthias Gawlitza, MD
Michael Moche, MD
Georg Wiltberger, MD
Johann Pratschke, MD
Moritz Schmelzle, MD
Publikationsdatum
02.01.2018
Verlag
Springer Vienna
Erschienen in
European Surgery / Ausgabe 1/2018
Print ISSN: 1682-8631
Elektronische ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-017-0507-8

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