Clinical Analysis of Injury of Bile Duct System during Operation for Gastric Cancer and Postoperative Changes of Liver Function Tests

Min, Jun Hong; Yang, Dae Hyun; Yun, Jin; You, Byung Uk; Kim, Il Myung; Park, Sang Su; Choi, Wonjin; Chae, Kibong; Jo, Ik Haeng

Abstract

BACKGROUND/AIMS: Hepatoduodenal ligament lymph node (LN) dissection has been performed as a part of extended LN dissection during the operation for gastric cancer. And additional cholecystectomy has been performed for more radical node dissection and prevention of cholelithiasis in some centers. There are rare studies and reports about the injury of bile duct system with the operation for gastric cancer. The aim of this study is to evaluate the risk of biliary tree injury with LN dissection for gastric cancer.
METHODS
254 patients of gastric cancer were treated with gastrectomy with LN dissection at Kangnam general hospital between January 1996 and December 2001. Among this group, 151 patients of advanced gastric cancer underwent extended LN dissection of D2+alpha or D3 including hepatoduodenal ligament LN and 69 patients of early gastric cancer underwent D2. And we routinely conducted cholecystectomy for advanced and early gastric cancer. Of these patients, 5 cases without remained or recurred tumor of bile leakage after operation were reviewed. And we analyzed the changes of liver function tests (LFT) of 15 patients of early gastric cancer and 21 patients of advanced gastric cancer whose LFT follow-up data were available.
RESULTS
The rate of bile leakage was 2.3% (5 patients) after LN dissection of hepatoduodenal ligament for gastric cancer. Among this group, 3 patients underwent reoperation due to unexpected bile leakage and 2 patients underwent T tube choledochostomy due to minor injury to common hepatic duct on operation. One patient died of sepsis with continued bile leakage after T tube removal on the postoperative 41st day. The serum alkaline phosphatase was increased after operation especially in advanced gastric cancer without clinical significance and there was no other significant abnormality in LFT after hepatoduodenal LN dissection and cholecystectomy in non-recurrent cases.
CONCLUSION
Extended lymph node dissection including hepatoduodenal ligament LN and cholecystectomy may have the possibility of increasing the risk of bile duct injury. It is important to select the patients who will benefit from hepatoduodenal ligament LN dissection and cholecystectomy. And meticulous surgical technique to operate biliary tract and adequate management of biliary injury are needed.