J.Jpn. Surg. Soc.
ISSN 1880-1129

[Abstract] [Full Text PDF] （in Japanese / 3741KB） [Members Only And Two Factor Auth.]

J.Jpn. Surg. Soc.. 102(11): 826-830, 2001

Feature topic

EN BLOC RESECTION OF THE HEPATODUODENAL LIGAMENT FOR ADVANCED CARCINOMA OF THE BILIARY TRACT

1) Department of Surgery, Keio University School of Medicine, Tokyo, Japan
2) Department of Surgery, Nihon Kokan Hospital, Kawasaki, Japan

Motohide Shimazu1), Go Wakabayashi1), Minoru Tanabe1), Shigeyuki Kawachi1), Shin Takahashi2), Masaki Kitajima1)

Theoretically, en bloc resection of the hepatoduodenal ligament is considered to be the most radical procedure for advanced carcinoma of the biliary tract. However, this procedure involves perioperative difficulties such as hepatic ischemia, portal congestion, patency of reconstructed vessels, and high incidence of operative mortality, moreover, when it is combined with resection of the liver and/or pancreas. We developed several tactics in vascular reconstruction, hepatic resection, and pancreatoduodenectomy in order to decrease the operative morbidity and mortality. We preferred to anastomose the portal vein and hepatic artery separately to avoid total hepatic ischemia, and used the porto-systemic bypass during prolonged portal reconstruction. We resected the liver without vascular clamping to minlmize hepatic ischemia, and employed the sirnplified method of pancreatojejunostomy. To date, we performed 4 hepatoligamentectomies and 4 hepatoligamentpancreatoduodenectomies with no operative mortality, although long-term survivors were not encountered. This procedure should be evaluated with more clinical experiences after its safety and indication was established.

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