Detailed Abstract
[E-poster - Biliary & Pancreas (Biliary Disease/Surgery)]
[EP 158] Short-term Outcomes after Left Hepatic Trisectionectomy for Biliary Cancer
Shoji KAWAKATSU 1, Takashi MIZUNO 1, Junpei YAMAGUCHI 1, Shunsuke ONOE 1, Masaki SUNAGAWA 1, Nobuyuki WATANABE 1, Tsuyoshi IGAMI 1, Yukihiro YOKOYAMA 1, Tomoki EBATA 1
1 Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, JAPAN
Background : Left hepatic trisectionectomy (H123458-B) is a technically demanding and risky procedure. Due to the frequent invasion, it is often difficult to divide the right anterior portal vein (RAPV) before hepatectomy, causing congestive bleeding or failure to obtain a demarcation line.
Methods : Patients who underwent H123458-B for preoperatively diagnosed biliary cancer between 2010 and 2023 were reviewed retrospectively. Anatomical variations of portal vein, timing of dissection of RAPV (before or after hepatectomy), and short-term outcomes were assessed.
Results : A total of 163 patients were included, and the final pathology was biliary cancer in 160 patients (perihilar, n=149; intrahepatic, n=5; distal, n=3; and gallbladder cancer, n=3), and benign biliary stricture in 3 patients. Combined pancreatoduodenectomy, portal vein resection, and hepatic artery resection were performed in 13 (8.0%), 60 (36.8%), and 64 (39.3%) patients, respectively. Median (range) operative time was 606 (380-1012) min, Pringle time was 91 (34-198) min, and blood loss/body weight was 20.7 (4.0-74.1) mL/kg. The postoperative complication (> Clavien-Dindo grade IIIa) rate was 82.8 (125/163) %, and the in-hospital mortality was 3.7 (6/163) %. Patients with normal portal bifurcation (Type I), trifurcation (Type II), and independent right posterior portal vein (Type III) were 123, 7, and 33 patients, respectively (Watanabe, Surgery 2016). RAPV could not be divided before hepatectomy for 87 (70.7%), 3 (42.9%), and 7 (21.2%) patients in Type I, II, and III, respectively.
Conclusions : In most H123458-B patients, RAPV could not be divided before hepatectomy. Difficulty level might be determined by the type of portal vein ramifications.
Methods : Patients who underwent H123458-B for preoperatively diagnosed biliary cancer between 2010 and 2023 were reviewed retrospectively. Anatomical variations of portal vein, timing of dissection of RAPV (before or after hepatectomy), and short-term outcomes were assessed.
Results : A total of 163 patients were included, and the final pathology was biliary cancer in 160 patients (perihilar, n=149; intrahepatic, n=5; distal, n=3; and gallbladder cancer, n=3), and benign biliary stricture in 3 patients. Combined pancreatoduodenectomy, portal vein resection, and hepatic artery resection were performed in 13 (8.0%), 60 (36.8%), and 64 (39.3%) patients, respectively. Median (range) operative time was 606 (380-1012) min, Pringle time was 91 (34-198) min, and blood loss/body weight was 20.7 (4.0-74.1) mL/kg. The postoperative complication (> Clavien-Dindo grade IIIa) rate was 82.8 (125/163) %, and the in-hospital mortality was 3.7 (6/163) %. Patients with normal portal bifurcation (Type I), trifurcation (Type II), and independent right posterior portal vein (Type III) were 123, 7, and 33 patients, respectively (Watanabe, Surgery 2016). RAPV could not be divided before hepatectomy for 87 (70.7%), 3 (42.9%), and 7 (21.2%) patients in Type I, II, and III, respectively.
Conclusions : In most H123458-B patients, RAPV could not be divided before hepatectomy. Difficulty level might be determined by the type of portal vein ramifications.
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E-poster
E-Session 03/21 ALL DAY