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Updated: Apr 19, 2026
Application of the En Bloc Concept Combined with Anatomic Resection in Laparoscopic Hepatectomy
Published on: March 10, 2023
En bloc resection of the hepatoduodenal ligament for advanced biliary malignancy
Yuji Kaneoka1, Atsuyuki Maeda, Masatoshi Isogai
1Department of Surgery, Ogaki Municipal Hospital, 4-86 Minaminokawa, Ogaki, 503-8502, Japan, y-kaneoka@omh.ogaki.gifu.jp.
Background:
En bloc resection of the hepatoduodenal ligament (HDL) for advanced biliary malignancy by hepato-ligamento-pancreatoduodenectomy (HLPD) or hepatoligamentectomy (HL) remains challenging, and only short-term outcomes have been reported. We showed our surgical technique of HLPD and HL, and retrospectively investigated surgical outcomes of the patients.
Methods:
Between 2003 and 2014, we performed four HLPD and three HL including major hepatectomy with concomitant caudate lobectomy. Portal vein reconstruction (PVR) was performed with a right external iliac vein graft, and hepatic artery reconstruction (HAR) was accomplished with the heterogeneous artery using the continuous suturing method.
Results:
Mean operation time and blood loss were 575 ± 111 min and 1539 ± 950 mL, respectively, and patency of the reconstructed vessels was confirmed postoperatively in all cases. Histologically, negative surgical margins (R0) were achieved in 57% of patients, while the resected vascular invasion was confirmed in all patients. Overall morbidity was high at 57%, but we have achieved no postoperative mortality. Overall median survival time of the patients was 36 months, and a patient of HL survived over 5 years.
Conclusions:
En bloc resection of the HDL based on steady vascular reconstruction can improve the surgical outcome of biliary cancer in selected patients.
