Mode of Recurrence of Hilar Bile duct Carcinoma, and Importance of Occupational Diagnosis and Liver Functional Reserve Assessment

Takehide Asano, Kazuo Enomoto, Hiroshi Yamamoto, Susumu Kobayashi, Tohru Nagashima, Takeshi Uematsu, Hodaka Amano, Toshio Nakagouri, Hirotoshi Kinoshita, Shinichi Okazumi, Yoshiharu Tokoro, Harufumi Makino, Yoshifumi Matsui, Kaichi Isono

Department of Surgery (II), Chiba University

Sixty three resections of hilar bile duct carcinoma were performed in our department from 1973 to 1994. Study of the mode of recurrences of these curatively resected cases showed that recurrences at the hepatic side edge occurred in 57% of cases. This type of recurrence, however, was minimal in cases of which the distance of tumor edge from the hepatic side edge of the resected bile duct was more than 5 mm, called hw 0 cases. In order to proceed extended operation for obtaining hw 0 safely, both the accurate diagnosis of cancer occupation and assessment of liver functional reserve were important. For the accurate diagnosis of hepatic side cancer invasion, we recommend cine-cholangiography because it provides fine 3 dimensional rotating cholangiograms. We could, therefore, observe each bifurcation of hepatic duct without overalapping. To assess liver functional reserve, we recommend the MEGX test and measurement of the hepatic protein synthesis rate of needle biopsied liver. From their data, post hepatectomy liver failure might be avoided using the linear discernment method. Further, ongoing studies of 11C-methionine positron emission tomography of the liver could provide images of functional localization. Therefore, it may become a good tool for liver functional reserve analysis in the near future.

Key words
hilar bile duct carcinoma, cine-cholangiography, liver functional reserve

Reprint requests
Takehide Asano Department of Surgery (II), Chiba University
1-8-1 Inohama, Chuoh-ku, Chiba, 260 JAPAN

Accepted
July 6, 1994

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