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Liver Transection-First Approach in Left Trisectionectomy for Perihilar Cholangiocarcinoma
Isamu Hosokawa1, Hiroaki Shimizu2, Masayuki Ohtsuka3
1Department of Surgery, Teikyo University Chiba Medical Center, Chiba, Japan.
Annals of Surgical Oncology
|March 11, 2020
Summary
Left trisectionectomy (LT) for perihilar cholangiocarcinoma is complex. A new liver transection-first approach improves safety by delaying division of key vessels, reducing patient complications.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Gastroenterology
Background:
- Left trisectionectomy (LT) is a challenging procedure for perihilar cholangiocarcinoma.
- High postoperative morbidity and mortality rates are associated with conventional LT.
Purpose of the Study:
- To introduce and evaluate the safety and efficacy of the liver transection-first approach for LT.
- To reduce postoperative morbidity and mortality in patients undergoing LT for perihilar cholangiocarcinoma.
Main Methods:
- The liver transection-first approach involves initiating liver transection before dividing the right anterior hepatic artery (RAHA) and right anterior portal vein (RAPV).
- RAHA and RAPV are identified and divided after liver transection is complete, under a clear surgical field at the hepatic hilus.
Main Results:
- The liver transection-first approach facilitates easier identification and division of RAHA and RAPV.
- This approach is associated with reduced postoperative morbidity and mortality compared to conventional LT.
Conclusions:
- The liver transection-first approach offers a safer method for performing LT.
- This technique holds promise for improving outcomes in patients with perihilar cholangiocarcinoma.
