Technique of reconstruction of hepatic artery with simultaneous left hepatectomy or trisectionectomy for complicated perihilar cholangiocarcinoma: report of 3 cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XU Guangxun ,  YE Sheng , XIANG Canhong , WANG Kaiyu , WANG Liang

Department of Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, P. R. China;

Corresponding author：

YE Sheng, Email: ysa01178@btch.edu.cn

Keywords：

complicated hilar cholangiocarcinoma; hepatic artery invasion; hepatic artery resection and reconstruction; microsurgical technique

DOI：

10.7507/1007-9424.202208014

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To explore the technique of hepatic artery reconstruction in complicated hilar cholangiocarcinoma surgery. Method The clinicopathologic data of 3 patients with complicated hilar cholangiocarcinoma with arterial invasion underwent hepatic artery reconstruction in the Department of Hepatopancreatobiliary Center of Beijing Tsinghua Changgung Hospital from March to July 2022 were retrospectively analyzed. Results All 3 patients (case 1–3) were the males, aged 53, 68, and 56 years, respectively, and with hypertension or diabetes; the longitudinal diameters of the tumor were 3.5 cm, 3.0 cm, and 3.2 cm, respectively. All patients had the right hepatic artery invasion. Case 2 and 3 had the arterial stratification. The arterial defects after radical resection were 4.5 cm, 3 cm, and 3 cm, respectively. The right or right posterior hepatic artery was reconstructed by the autotransplantation of right gastroomental artery, the left hepatic artery, and the anterior superior pancreaticoduodenal artery, respectively. After operation, the reconstructed hepatic arteries were unobstructed and free of stenosis, and there were no complications such as bleeding, infection, and thrombosis by Doppler ultrasound and CT angiography. The results of postoperative pathological diagnosis were the hilar cholangiocarcinoma with arterial invasion, and all the incisal edges were negative. Conclusion From the preliminary results of 3 cases, it is safe, feasible, and effective to select proper autologous artery (matched in length and caliber) for reconstruction the defective invaded hepatic artery which resected together with hilar cholangiocarcinoma, but the technical difficulty is still relatively high.

Citation： XU Guangxun, YE Sheng, XIANG Canhong, WANG Kaiyu, WANG Liang. Technique of reconstruction of hepatic artery with simultaneous left hepatectomy or trisectionectomy for complicated perihilar cholangiocarcinoma: report of 3 cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(10): 1273-1278. doi: 10.7507/1007-9424.202208014 Copy

1.	Mizuno T, Ebata T, Nagino M. Advanced hilar cholangiocarcinoma: an aggressive surgical approach for the treatment of advanced hilar cholangiocarcinoma: perioperative management, extended procedures, and multidisciplinary approaches. Surg Oncol, 2020, 33: 201-206.
2.	Natsume S, Ebata T, Yokoyama Y, et al. Clinical significance of left trisectionectomy for perihilar cholangiocarcinoma: an appraisal and comparison with left hepatectomy. Ann Surg, 2012, 255(4): 754-762.
3.	Igami T, Nishio H, Ebata T, et al. Surgical treatment of hilar cholangiocarcinoma in the “new era”: the Nagoya University experience. J Hepatobiliary Pancreat Sci, 2010, 17(4): 449-454.
4.	Peng C, Li C, Wen T, et al. Left hepatectomy combined with hepatic artery resection for hilar cholangiocarcinoma: a retrospective cohort study. Int J Surg, 2016, 32: 167-173.
5.	Xiang S, Lau WY, Chen XP. Hilar cholangiocarcinoma: controversies on the extent of surgical resection aiming at cure. Int J Colorectal Dis, 2015, 30(2): 159-171.
6.	Whitley A, Baláž P. Gastroduodenal artery as an inflow artery for right hepatic artery reconstruction. Eur J Vasc Endovasc Surg, 2021, 61(1): 88. doi: 10.1016/j.ejvs.2020.07.008.
7.	Yilmaz S, Akbulut S, Kutluturk K, et al. Using the recipient’s left gastric artery for hepatic artery reconstruction in living donor liver transplantation. Liver Transpl, 2021, 27(6): 923-927.
8.	Tinelli G, Montanari F, Sica S, et al. Splenic artery transposition for hepatic arterial reconstruction in a locally advanced pancreatic cancer: a case report and literature review. Eur Rev Med Pharmacol Sci, 2021, 25(10): 3679-3683.
9.	Yilmaz S, Akbulut S, Kutluturk K, et al. Splenic artery transposition for hepatic artery reconstruction during liver transplantation: is it the best choice for adequate arterial inflow in extraordinary conditions? Liver Transpl, 2021, 27(4): 595-599.
10.	Shindo Y, Tokumitsu Y, Matsukuma S, et al. Hepatic artery resection and reconstruction using the right gastroepiploic artery during pancreaticoduodenectomy in advanced pancreatic cancer. Langenbecks Arch Surg, 2021, 406(6): 2075-2080.
11.	Ozer A, Aktas H, Eren N, et al. Hepatic arterial reconstruction using right gastroepiploic artery in living donor liver transplantation. Transplant Proc, 2018, 50(10): 3559-3561.
12.	Özbilgin M, Ünek T, Egeli T, et al. Hepatic artery reconstruction with autologous inferior mesenteric artery graft in living donor liver transplant recipients. Transplant Proc, 2017, 49(3): 566-570.
13.	Fong HC, Tan EK, Chew KY, et al. Hepatic artery reconstruction in living donor liver transplantation with the radial artery interpositional graft. Transplant Proc, 2021, 53(5): 1659-1664.
14.	Aryal B, Komokata T, Kadono J, et al. First jejunal artery, an alternative graft for right hepatic artery reconstruction. World J Hepatol, 2015, 7(4): 721-724.
15.	Matsumoto T, Kubota K, Aoki T, et al. A novel approach for hepatic arterial reconstruction after total pancreatectomy with common hepatic artery resection using inferior phrenic artery. Dig Surg, 2019, 36(2): 99-103.
16.	Paterno F, Brown L, Wilson D, et al. Novel arterial reconstruction with donor femoral artery in split-liver transplantation. Liver Transpl, 2020, 26(3): 456-460.

1. Mizuno T, Ebata T, Nagino M. Advanced hilar cholangiocarcinoma: an aggressive surgical approach for the treatment of advanced hilar cholangiocarcinoma: perioperative management, extended procedures, and multidisciplinary approaches. Surg Oncol, 2020, 33: 201-206.
2. Natsume S, Ebata T, Yokoyama Y, et al. Clinical significance of left trisectionectomy for perihilar cholangiocarcinoma: an appraisal and comparison with left hepatectomy. Ann Surg, 2012, 255(4): 754-762.
3. Igami T, Nishio H, Ebata T, et al. Surgical treatment of hilar cholangiocarcinoma in the “new era”: the Nagoya University experience. J Hepatobiliary Pancreat Sci, 2010, 17(4): 449-454.
4. Peng C, Li C, Wen T, et al. Left hepatectomy combined with hepatic artery resection for hilar cholangiocarcinoma: a retrospective cohort study. Int J Surg, 2016, 32: 167-173.
5. Xiang S, Lau WY, Chen XP. Hilar cholangiocarcinoma: controversies on the extent of surgical resection aiming at cure. Int J Colorectal Dis, 2015, 30(2): 159-171.
6. Whitley A, Baláž P. Gastroduodenal artery as an inflow artery for right hepatic artery reconstruction. Eur J Vasc Endovasc Surg, 2021, 61(1): 88. doi: 10.1016/j.ejvs.2020.07.008.
7. Yilmaz S, Akbulut S, Kutluturk K, et al. Using the recipient’s left gastric artery for hepatic artery reconstruction in living donor liver transplantation. Liver Transpl, 2021, 27(6): 923-927.
8. Tinelli G, Montanari F, Sica S, et al. Splenic artery transposition for hepatic arterial reconstruction in a locally advanced pancreatic cancer: a case report and literature review. Eur Rev Med Pharmacol Sci, 2021, 25(10): 3679-3683.
9. Yilmaz S, Akbulut S, Kutluturk K, et al. Splenic artery transposition for hepatic artery reconstruction during liver transplantation: is it the best choice for adequate arterial inflow in extraordinary conditions? Liver Transpl, 2021, 27(4): 595-599.
10. Shindo Y, Tokumitsu Y, Matsukuma S, et al. Hepatic artery resection and reconstruction using the right gastroepiploic artery during pancreaticoduodenectomy in advanced pancreatic cancer. Langenbecks Arch Surg, 2021, 406(6): 2075-2080.
11. Ozer A, Aktas H, Eren N, et al. Hepatic arterial reconstruction using right gastroepiploic artery in living donor liver transplantation. Transplant Proc, 2018, 50(10): 3559-3561.
12. Özbilgin M, Ünek T, Egeli T, et al. Hepatic artery reconstruction with autologous inferior mesenteric artery graft in living donor liver transplant recipients. Transplant Proc, 2017, 49(3): 566-570.
13. Fong HC, Tan EK, Chew KY, et al. Hepatic artery reconstruction in living donor liver transplantation with the radial artery interpositional graft. Transplant Proc, 2021, 53(5): 1659-1664.
14. Aryal B, Komokata T, Kadono J, et al. First jejunal artery, an alternative graft for right hepatic artery reconstruction. World J Hepatol, 2015, 7(4): 721-724.
15. Matsumoto T, Kubota K, Aoki T, et al. A novel approach for hepatic arterial reconstruction after total pancreatectomy with common hepatic artery resection using inferior phrenic artery. Dig Surg, 2019, 36(2): 99-103.
16. Paterno F, Brown L, Wilson D, et al. Novel arterial reconstruction with donor femoral artery in split-liver transplantation. Liver Transpl, 2020, 26(3): 456-460.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Technique of reconstruction of hepatic artery with simultaneous left hepatectomy or trisectionectomy for complicated perihilar cholangiocarcinoma: report of 3 cases

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