J.Jpn. Surg. Soc.. 120(2): 196-200, 2019

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Feature topic

PERIHILAR CHOLANGIOCARCINOMA: MAJOR VASCULAR INVASION AT THE HEPATIC HILUS

The hilar bile duct is located just anterior to the portal bifurcation with the right hepatic artery running between them. This anatomic feature leads to frequent invasion of the major vasculature of the hepatoduodenal ligament in patients with perihilar cholangiocarcinomas. Cases with unilateral vascular invasion can be resected with the standardized surgical approach of right or left hemihepatectomy with caudate lobectomy. Tumors tend to invade the contralateral/bilateral vasculature with disease progression. This extensive feature was previously a local sign of unresectable disease, although an extended approach using hepatectomy combined with vascular resection has recently been utilized with curative intent. Portal vein resection followed by reconstruction is globally accepted as an extended surgical approach, with a considerable number of supporting studies. On the other hand, hepatic artery resection remains controversial because of the very limited number of studies with a small sample size, where demanding techniques, high morbidity rates, and unclear long-term survival benefit were demonstrated. Therefore, hepatic artery resection for the treatment of perihilar cholangiocarcinoma, in contrast to portal vein resection, should be performed in specialized centers.

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