Stoyanova Radoslava, Kopf Helmut, Schima Wolfgang, Matzek Wolfgang Karl, Klaus Alexander
Department of Surgery, Barmherzige Schwestern Krankenhaus, 1060 Vienna, Austria.
Department of Diagnostic and Interventional Radiology, Barmherzige Schwestern Krankenhaus, 1060 Vienna, Austria.
Explor Target Antitumor Ther. 2022;3(1):90-96. doi: 10.37349/etat.2022.00073. Epub 2022 Feb 28.
Hilar cholangiocarcinoma is a rare primary malignancy associated with a dismal prognosis. Currently, complete extended right or left-sided hepatectomy is the primary curative therapy. Achieving a negative resection margin is associated with long-term survival and better quality of life, while post-hepatectomy liver failure (PHLF) due to insufficient liver remnant remains the most dreaded complication with a negative effect on overall survival. Precise preoperative management with sufficient future remnant liver (FRL) volume is the key to achieving good results in the treatment of bile duct carcinoma. To present a case report and a literature review for preoperative FRL optimization prior to major hepatectomies for hilar cholangiocarcinoma. Improvement of postoperative outcomes after extended liver resections in the case of hilar cholangiocarcinoma. A 62-year-old Caucasian woman with Lynch syndrome presented to our department with a hilar cholangiocarcinoma Bismuth type IIIa. The patient had an insufficient future liver volume for extended liver resection. She underwent preoperative preconditioning using a liver venous deprivation (LVD) and underwent two weeks later a right trisectorectomy without any interventional complications. Liver function remained stable postoperatively. The patient was discharged on the 20th postoperative day without major surgical post-operative complications or the need for readmission. LVD is a technically feasible, safe, and effective procedure to increase the FRL in a short period of time with low intra and post-operative complications and therefore improving the survival of patients with hilar cholangiocarcinoma.
肝门部胆管癌是一种罕见的原发性恶性肿瘤，预后较差。目前，完整的扩大右半肝或左半肝切除术是主要的根治性治疗方法。实现切缘阴性与长期生存及更好的生活质量相关，而由于剩余肝组织不足导致的肝切除术后肝功能衰竭（PHLF）仍是最可怕的并发症，对总体生存有负面影响。精确的术前管理，确保有足够的未来剩余肝脏（FRL）体积，是胆管癌治疗取得良好效果的关键。本文旨在呈现一例肝门部胆管癌扩大肝切除术前优化FRL的病例报告及文献综述，以改善肝门部胆管癌扩大肝切除术后的预后。一名患有林奇综合征的62岁白人女性因肝门部胆管癌Bismuth IIIa型就诊于我院。该患者未来肝脏体积不足以进行扩大肝切除。她接受了术前肝静脉阻断（LVD）预处理，两周后接受了右半肝三叶切除术，未出现任何介入相关并发症。术后肝功能保持稳定。患者术后第20天出院，无重大手术相关并发症，也无需再次入院。LVD是一种技术上可行、安全且有效的方法，可在短时间内增加FRL，术中及术后并发症发生率低，从而提高肝门部胆管癌患者的生存率。
