Surgical Approaches for Carcinoma of the Hepatic Duct Confluence with Hepatic Vascular Resection and Reconstruction

Masaru Miyazaki, Ikuo Udagawa, Hisao Koshikawa, Katsuhiro Iinuma, Hiroshi Itoh, Yayoi Kanno, Takashi Kaiho, Fumio Kimura, Jun Matsumoto, Toshio Isono, Hirouki Suzuki, Takashi Koyama, Tsukasa Shimoda, Kohji Nakagawa, Katsuji Okui, Kazuya Hayashida*, Toshikazu Suwa*

First Department of Surgery, Chiba University School of Medicine
*Ohmiya Red Cross Hospital

Twenty six patients with carcinoma of the hepatic duct confluence were treated by surgical excision with hepatic hilar vascular resection and reconstruction in 9 patients and without vascular resection in 17 patients. In only two patients (7.7%) was the treatment performed as histological curative resection, in 14 as relative curative resection and in 10 as absolute noncurative resection without obvious differences between the which groups. The "ew" factor was positive in 88% of patients who received a resection, there was no differences in it's incidence between the two groups. The "hw" factor was positive in 22% of the patients with vascular resection and reconstruction, but in 47% of the patients without vascular resection. Two postoperative deaths occurred both in patients with vascular resection and reconstruction. Survival rates for patients without vascular resection were 67.3% at 1 year, 34.6% at 3 years and 34.0% at 5 years but only 20.0% at 1 year for patients with vascular resection and reconstruction. These results suggest that although hepatic hilar vascular resection and reconstruction induces the slight improvement in histological curability, these aggressive surgical approaches can not always achieve a satisfactory outcome. Vascular involvement at the hepatic hilus would be predictive of poor prognosis in carcinoma of the hepatic duct confluence. To improve the prognosis of carcinoma of the hepatic duct confluence with hepatic hilar vascular involvement, other effective therapeutic modalities should be investigated as additional treatments to the aggressive surgical approaches.

Key words
carcinoma of the hepatic duct confluence, hepatectomy with vascular resection and reconstruction

Reprint requests
Masaru Miyazaki First Department of Surgery, Chiba University School of Medicine
1-8-1 Inohana, Chiba, 280 JAPAN

Accepted
September 12, 1990

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