Abu Hilal Mohammed, Badran Abdallah, Di Fabio Francesco, Pearce Neil William
Hepatobiliary-Pancreatic and Laparoscopic Surgical Unit, Southampton General Hospital, Southampton University Hospitals NHS Trust, Southampton, United Kingdom.
J Laparoendosc Adv Surg Tech A. 2011 Nov;21(9):845-9. doi: 10.1089/lap.2011.0247. Epub 2011 Aug 19.
There is an ongoing debate on whether it is safe to push the boundaries and widen the indications of laparoscopic liver surgery after careful patient selection. We report 2 cases of pure laparoscopic en bloc left hemihepatectomy and caudate lobe resection for intrahepatic cholangiocarcinoma (ICC).
The first patient (a 79-year old) had an ICC affecting segments 2, 3, and 4 of the liver with dilatation of segment 1 ducts at preoperative imaging. The second patient (an 81-year old) had an ICC affecting segments 2, 3 with local invasion of segment 1. Both patients underwent pure laparoscopic left hemihepatectomy and caudate lobe resection.
The first patient's operative time was 360 minutes and blood loss was 390 mL. Postoperative hospital stay was 8 days. The definitive histology was as follows: pT1 ICC (25 mm in maximal diameter), with 20 mm free resection margin. The second patient's operative time was 310 minutes and blood loss was 300 mL. Postoperative hospital stay was 4 days. The definitive histology was as follows: T1 ICC (49 mm in maximal diameter) with 10 mm free resection margin. The first patient was disease free 12 months after surgery. The second patient died 11 months after surgery of metastatic disease.
Pure laparoscopic left hemihepatectomy and caudate lobectomy for ICC may be feasible and safe. This is, however, a very complex procedure requiring extensive experience in laparoscopic liver surgery and careful patient selection to optimize surgical outcome. To our knowledge, this is the first systematic description of a pure laparoscopic en bloc left hemihepatectomy and caudate lobe resection for ICC.
对于在仔细筛选患者后拓展腹腔镜肝手术的边界及扩大其适应证是否安全，目前仍存在争议。我们报告2例因肝内胆管癌（ICC）行单纯腹腔镜整块左半肝切除术及尾状叶切除术的病例。
首例患者（79岁），术前影像学检查显示肝内胆管癌累及肝段2、3和4，肝段1胆管扩张。第二例患者（81岁），肝内胆管癌累及肝段2、3，侵犯肝段1。两名患者均接受了单纯腹腔镜左半肝切除术及尾状叶切除术。
首例患者手术时间为360分钟，出血量为390毫升。术后住院时间为8天。最终组织学检查结果如下：pT1期肝内胆管癌（最大直径25毫米），切缘阴性20毫米。第二例患者手术时间为310分钟，出血量为300毫升。术后住院时间为4天。最终组织学检查结果如下：T1期肝内胆管癌（最大直径49毫米），切缘阴性10毫米。首例患者术后12个月无疾病复发。第二例患者术后11个月死于转移性疾病。
因ICC行单纯腹腔镜左半肝切除术及尾状叶切除术可能是可行且安全的。然而，这是一个非常复杂的手术，需要丰富的腹腔镜肝手术经验以及仔细的患者筛选，以优化手术效果。据我们所知，这是首例关于因ICC行单纯腹腔镜整块左半肝切除术及尾状叶切除术的系统描述。
