Ebata Tomoki, Ito Takaaki, Yokoyama Yukihiro, Igami Tsuyoshi, Sugawara Gen, Mizuno Takashi, Nagino Masato
Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
J Hepatobiliary Pancreat Sci. 2014 Aug;21(8):E57-61. doi: 10.1002/jhbp.121. Epub 2014 Jun 10.
Perihilar cholangiocarcinomas often involve the bifurcation of the portal vein and the hepatic artery at initial presentation. Previously, vascular invasion was a major obstacle for R0 resection; therefore, such tumors were regarded as locally advanced, unresectable disease. Recently, in leading centers, these tumors have been resected using a specific technique, vascular resection and reconstruction. Vascular resection is classified into three types: portal vein resection alone, hepatic artery resection alone, and simultaneous resection of both the portal vein and hepatic artery. Of these, portal vein resection is widely performed, whereas hepatic artery resection remains controversial. Therefore, hepatectomy combined with simultaneous resection of the portal vein and hepatic artery represents one of the most complicated and challenging procedures in hepatobiliary surgery. The survival benefit of this extended procedure remains unproven, and there is only a single study reporting an unexpectedly favorable outcome in 50 patients. Considering the dismal survival in patients with unresectable disease, hepatic artery resection and/or portal vein resection may be a promising option of choice. However, the technique is highly demanding and has not been standardized. Therefore, this extended surgery may be allowed only in selected hepatobiliary centers.
肝门部胆管癌在初次就诊时通常累及门静脉和肝动脉的分叉处。以前，血管侵犯是R0切除的主要障碍；因此，这类肿瘤被视为局部晚期、不可切除的疾病。最近，在一些领先的中心，这些肿瘤已通过一种特定技术，即血管切除和重建进行了切除。血管切除分为三种类型：单纯门静脉切除、单纯肝动脉切除以及门静脉和肝动脉同时切除。其中，门静脉切除应用广泛，而肝动脉切除仍存在争议。因此，肝切除术联合门静脉和肝动脉同时切除是肝胆外科中最复杂且具有挑战性的手术之一。这种扩大手术的生存获益尚未得到证实，仅有一项研究报告了50例患者出人意料的良好结果。考虑到不可切除疾病患者的生存情况不佳，肝动脉切除和/或门静脉切除可能是一个有前景的选择。然而，该技术要求很高且尚未标准化。因此，这种扩大手术可能仅在选定的肝胆中心进行。
