Clinical significance of reconstruction of the right hepatic artery for biliary malignancy

Yoshihiro Sakamoto, Tsuyoshi Sano, Kazuaki Shimada, Tomoo Kosuge, Yoshihiro Kimata, Minoru Sakuraba, Junji Yamamoto, Hidenori Ojima

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48 Citations (Scopus)

Abstract

Background and aims: The clinical significance of resectional surgery with reconstruction of the right hepatic artery for biliary malignancy remains unclear. Patients/methods: Between 1990 and 2004, six patients (5%) with cholangiocarcinoma and five patients (3%) with gallbladder carcinoma with possible involvement of the right hepatic artery underwent resectional surgery with reconstruction of the right-sided hepatic artery. The surgical procedures included extended left hemihepatectomy (n=4), left trisectionectomy (n=1), central bisegmentectomy (n=1), resection of anterior segment and inferior area of segment 4 (n=2), resection of segment 5 and inferior area of segment 4 (n=1), and extrahepatic bile duct resection (n=2). Segmental resection and reconstruction of the right (n=7), anterior (n=1), or posterior (n=3) hepatic artery was performed by end-to-end anastomosis (n=5), using the right gastroepiploic artery (n=4), the gastroduodenal artery (n=1), or an autologous venous graft (n=1). Results: There was no in-hospital mortality. Histopathological arterial involvement was present in seven patients, and the surgical margin was positive in five patients. The median survival was 23 months in R0 patients (n=6), while it was 13 months in R1 patients (n=5) (p=0.16). Conclusion: Reconstruction of the right hepatic artery was safely performed in patients with biliary malignancy. Arterial reconstruction can be indicated when the arterial involvement is the only obstacle to obtain negative surgical margins.

Original languageEnglish
Pages (from-to)203-208
Number of pages6
JournalLangenbeck's Archives of Surgery
Volume391
Issue number3
DOIs
Publication statusPublished - 2006 Jun
Externally publishedYes

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Keywords

  • Arterial involvement
  • Biliary malignancy
  • Hepatic artery reconstruction
  • Right gastroepiploic artery
  • Surgical margins

ASJC Scopus subject areas

  • Surgery

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