Rational Resection of the Right Dorsal Liver for Hepatic Hilar Bile Duct Carcinoma

Shuichi Ishiyama, Akira Fuse, Hiroshi Kuzu, Kiyoshi Kawaguchi, Masaru Tsukamoto

First Department of Surgery, Yamagata University School of Medicine

Rational resection of the right dorsal liver for hepatic hilar bile duct carcinoma was proposed. While the importance of the caudate lobe has been recognized, the rational right resecting limit of the dorsal liver is still contraversial. In order to determine the rational limit, we examined 63 liver casts made of silicon rubber about the anatomy of the bile ducts of the hepatic hilus and the right dorsal liver. The distances from the junction of the hepatic ducts to the junction of the lateral bile ducts (B2 and B3), and of the posterior ones (B6 and B7) were 2.58 cm and 2.11 cm, respectively. These distances are considered the bilateral resecting limits of the bile ducts in the generally performed radical operations for this disease. Most of the bile ducts (94.3%) from the paracaval portion of the caudate lobe flowed into the more duodenal or left side than into the junction of the B6 and B7. We found that there was liver parenchyma (dorso-lateral paracaval portion) fed by the portal branches originating from the posterior portal trunk in 59.3% of the cases and that 87.5% of the corresponding bile ducts flowed into the posterior bile duct trunk. From these findings, we believe that we have to resect the right side bile duct over the junction of the B6 and B7, and that we have to resect not only the caudate lobe but also the dorso-lateral paracaval portion when hepatectomy for hepatic hilar bile duct carcinoma is performed from the left side.

Key words
hepatic hilar bile duct carcinoma, resection of the dorsal liver, caudate lobectomy, paracaval portion of the caudate lobe, anatomy of the hilar bile duct

Reprint requests
Shuichi Ishiyama First Department of Surgery, Yamagata University School of Medicine
2-2-2 Iida-Nishi, Yamagata, 990-23 JAPAN

Accepted
July 2, 1997

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