Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver.

TLDR

Resection of hilus liver tumors typically requires hepatectomy and is justified only when all tumor can be removed, necessitating careful staging for metastases and biopsy. The study aims to broaden the indications for resection of hilus tumors by evaluating alternative surgical strategies. When resection is infeasible, the authors employ cholangiogram‑guided intrahepatic cholangioenteric anastomosis—preferably via the round ligament or segment V duct—choosing unilateral or double anastomoses based on ductal invasion. Cholangiogram‑guided anastomosis improves survival and quality of life, allowing many young patients to live years with renewed well‑being even when the tumor cannot be removed, and reducing biliary complications.

Abstract

It is important to expand the indications for resection of tumors of the hilas, generally requiring associated hepatectomy, after careful search for metastases and biopsy of any suspicious areas makes this reasonable. One can justify such a procedure, representing a major stress and a considerable mortality rate, only if one is sure that all the tumor will be removed. If resection cannot be carried out, a unilateral intrahepatic cholangioenteric anastomosis with preference for the round ligament technique is an excellent procedure when properly applied. If a contraindication to a left sided anastomosis exists, particularly invasion of the left sided confluences, the anastomosis is made on the right to the duct of segment V. Study of the cholangiogram with attenion to the primary and secondary confluences directs a decision to perform a double anastomosis the ducts are not dilated or a poor quality anastomosis is all that can be achieved on one side and when secondary confluents are involved on both sides. The results of a variety of techniques emphasize the importance of the cholangiogram in choosing the location of an anastomosis and the role of invasion of primary and secondary conversions in choosing the technique. Many of thse patients are young and, even if no resection is possible, amy survive several years. A renewed sense of well being and prolongation of life are achievable goals even if the tumor cannot be removed. There is every reason to offer the maximum to these patients so that, if they muse eventually die, it will be from the tumor itself and not from its biliary complications.