Application of portal parenchyma-enterostomy after high hilar resection for Bismuth type IV hilar cholangiocarcinoma.

For the surgical treatment of Bismuth Type IV hilar cholangiocarcinoma, it is difficult to achieve curative resection (R0 resection) with restrictive excision (local resection and parenchyma-preserving liver resection) as a result of the complexity and difficulty in biliary reconstruction. Extended hepatectomy with vessel resection can improve the rate of curative resection, but it can also give rise to postoperative complications and mortality. We proposed a high hilar resection and portal parenchyma-enterostomy method to improve the surgical procedure. Eleven patients with Bismuth IV hilar cholangiocarcinoma underwent high hilar resection (resection for tumors in bile ducts and 1 cm above the tumors including segments IVb, V, and part of the caudate liver lobe) and the biliary tract was reconstructed through a portal parenchyma-enterostomy. Biliary radicles were not ligated but were drained into the "bile lake." No cases of perioperative death were observed. Four weeks after surgery, patients' serum aspartate aminotransferase, alanine aminotransferase, and total bilirubin were decreased evidently. The average survival was 25.3 months. In conclusion, the portal parenchyma-enterostomy procedure can be performed with increased curative rate and reduced parenchyma resection, extending the survival time of patients and improving patients' quality of life.