Treatment of Proximal Bile Duct Cancer -Experimental and Clinical Background of Nagoya Strategy-

Yuji Nimura

1st Department of Surgery, Nagoya University School of Medicine

Surgical treatment of proximal bile duct cancer have been developed in our country. In this article, the surgical strategy of Nagoya University is described while introducing experimental and clinical experiences with this difficult disease. Basic strategies of perioperative managements are as follows. 1. Multiple selective percutaneous transhepatic biliary drainage which leads to take selective cholangiography with or without percutaneous transhepatic cholangioscopy to diagnose the cancer extension and to treat segmental cholangitis. 2. Percutaneous transhepatic portal vein embolization to increase safety of major hepatobiliary resection. 3. Hepatic segmentectomy with caudate lobectomy should be performed after careful estimation of the functional capacity of the future remnant liver segment. 4. Combined portal vein and hepatobiliary resection can be advisable. 5. Externally drained bile should be ingested into the gastrointestinal tract together with elental diet during pre and postoperative managements of the patient. 6. Color doppler ultrasonography is helpful to estimate the liver blood flow and to predict the liver function of the patients who underwent portal vein embolization and hepatobiliary resection.

Key words
hilar cholangiocarcinoma, percutaneous transhepatic biliary drainage, hepatectomy

Reprint requests
Yuji Nimura First Department of Surgery, Nagoya University School of Medicine 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 JAPAN

Accepted
November 13, 1998

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