J.Jpn. Surg. Soc.. 120(2): 183-188, 2019

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Feature topic

SURGICAL RESECTION OF INTRAHEPATIC CHOLANGIOCARCINOMA WITH MAJOR VASCULAR INVASION

Intrahepatic cholangiocarcinoma (ICC) easily invades neighboring major vessels such as the portal vein (PV), hepatic artery (HA), and inferior vena cava (IVC). Surgical treatment for such cases had been regarded as a relative contraindication due to high surgical invasiveness and high surgical mortality and morbidity rates. However, in recent years, with the improvement of surgical management, extended hepatic resection with combined vascular resection has been attempted. Consequently, surgical resection is technically feasible for the treatment of ICC patients with vascular invasion if R0 resection is performed and vascular reconstruction is possible. Technically, it is important to plan suitable methods of vascular clamping and vascular reconstruction based on perioperative imaging diagnosis of the site and extent of vascular invasion. In some reports, combined PV and/or IVC resection was shown not to be associated with worse perioperative or long-term outcomes in patients with ICC, and similar results were obtained in our experience. However, the significance of combined HA resection and reconstruction has not yet been clarified, because there is no report on ICC cases undergoing this procedure. Although extended hepatic resection with combined vascular resection for ICC patients could be performed relatively safely, the thorough preoperative examinations, stable techniques, and delicate perioperative management required are demanding. Therefore, these surgeries should be performed in specialized institutions.

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