Segments I and IV resection as a new approach for hepatic hilar cholangiocarcinoma.

Major hepatic resection for biliary tract carcinoma with obstructive jaundice has been reported on as bringing about high surgical morbidity and mortality rates. It has been also revealed that the extent of hepatic resection is closely associated with the occurrence of postoperative complications. Therefore, hepatic resection, limited as much as possible to what is necessary for curative resection, should be performed according to cancer extent. We performed a new surgical approach in 3 patients with hepatic hilar cholangiocarcinoma that included total resection of hepatic segments I and IV (by Couinaud's classification) and bile duct resection with hepaticojejunostomy of 4 to 6 intrahepatic bile duct stumps. All patients underwent curative surgical resections and were discharged within 6 weeks after surgery, without any serious complications. This limited resection of hepatic segments I and IV could be an effective radical surgical procedure for hepatic hilar cholangiocarcinoma, to avoid the occurrence of postoperative liver failure.