Intrahepatic bile duct approach through central hepatic dissection (segment IVa) for type IV hilar cholangiocarcinoma

초록

OBJECTIVE: TO evaluate the usefulness of central hepatic dissection in type IV Hilar cholangiocainoma, a clinicopathologic stydy was performed on 16 resected patients. Curative resection depends on negative surgical margin of bile duct, and hepatic resection is nessary to achieve this. METHODS: Between 1994 and 2001, 16 patients with Bismuth-Corlette type IV hilar cholangicocarcinoma underwent a radical resection, which in all was combined with a hepatic resection. Central hepatic dissection was applied to patients for negative surgical margin. According to pathologic reports, we reviewed the surgical margn status. RESULTS: Curative resection(RO) involving negative surgical margin was possible in 12(75%) of the 16 patients, and all patients underwent various types of hepatectomy with caudate lobe resection for a 30-day operative rate of 6.2%(1 patient). Combined pancreaticoduodenectomy was performed in 2 patients. According to TNM staging system, 10 (62%) of 16 patients were stage IV, 3 were stage III and 3 were stage II. CONCLUSION: Curative surigical resection (R0) provides the best survival for hilar cholangiocarcinoma. If central hepatic dissection was applied to the surgical procedure before hepatic resection, negative surgical margin could obtained by the least hepatic resection, which could reduce the postioerative morbidity and mortality.