J Korean Surg Soc.
2000 Apr;58(4):551-559.
Clinical Outcome of Major Hepatobiliary Resections for Malignant Tumor of the Extrahepatic Biliary Tree
- Affiliations
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- 1Department of Surgery, Seoul National University College of Medicine.
Abstract
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PURPOSE: A major hepatobiliary resection (MHBR), liver resection of more than one lobe, has been
recommended by some surgeons for advanced carcinomas (Ca) of the gallbladder (GB) and the hilar
bile duct (HBD). However, high operative mortality and morbidity have been reported and its survival
benefit has not been clearly documented. METHODS: We report the results of MHBR for such tumors
to determine the safety and the effectiveness of this operation, which has been performed for GB Ca
invading the right hepatic pedicle or liver bed by 2 cm or more and for HBD Ca of Bismuth type III
or IV. The cases of fifty consecutive cases who received MHBR for GB Ca (n=11) or HBD Ca (n=39)
during a 5 year-period were reviewed. RESULTS: Thirty right-sided and 20 left-sided hepatectomies were
performed. There was no operative or hospital death. Minor and major complications developed in 64%
of the cases. All the complications improved with conservative management, except two in which re
operations were required, one due to portal vein thrombosis and the other to bleeding of the retro
peritoneal dissection site. No specific factors were associated with the high complication rate. The
long-term outcome of HBD Ca was better than that of GB Ca. In HBD Ca, differentiated cancer
and less transfusion were associated with a better prognosis. CONCLUSION: MHBR was
conducted with acceptable morbidity and no mortality. In terms of the long-term outcome,
MHBR is recommended for HBD Ca whereas it should be considered more carefully for GB
Ca.