Hemihepatectomy combined with hepatic artery resection for Bismuth III, IV hilar bile duct carcinoma: result of 43 cases

Objective To explore the effect and safety of combination of hemihepatectomy and hepatic artery resection for Bismuth Ⅲ,Ⅳ hilar cholangiocarcinoma.Methods A retrospective analysis was made on 43 cases operated from May 2003 to June 2012,including right hemihepatectomy in 12 cases,lefi liver resection in 28 cases,left trisegmentectomy in 3 cases,combined caudate lobe resection in 19 cases,all were with proper hepatic arterectomy,in those cases portal vein resection and reconstruction was carried out in 5 cases,hepatic artery reconstruction in 2 cases.Preoperative PTCD was performed in 5 cases in whom age ＞ 70 and bilirubin ＞ 300 μmol/L.Results Radical resection rate was 58.1％(25/43),5 cases were well-differentiated adenocarcinoma,13 cases of moderately differentiated adenocarcinoma,poorly differentiated adenocarcinoma in 18 cases,papillary carcinoma in 2 cases,mucous adenocarcinoma in 4 cases,sclerosing adenocarcinoma in 1 case,the incidence of postoperative complications was 39.5％ (17/43) including hepatic abscess (3 cases),biliary fistula (4 cases),hepatic insufficiency and massive ascites in 4 cases,portal vein stenosis after reconstruction in 2 cases,hepatic artery obliteration after reconstruction in 1 case,gastric paralysis in 3 cases.There was no inhospital death.1,3,5 year survival rates were 93.0％ (40/43),39.5％ (17/43),and27.9％ (12/43).Conclusions In Bismuth Ⅲ,Ⅳ hilar cholangiocarcinoma,in whom hepatic artery obliteration is common,hepatic arterectomy is safe and feasible,however,concurrent hepatic artery reconstruction is mandatory in those with the reconstruction of the portal vein. Key words: Bile duct neoplasms ;  Hepatectomy ;  Hepatic artery ;  Vascular resection