A Case of Extended Right Hepatic Lobectomy for Hepatic Hilar Duct Cancer Complicated by Nonalcoholic Steatohepatitis

Seiji Oguro, Takanori Aoki, Chikayoshi Tani, Sachiko Kenno, Tatsushi Shimokuni, Kouji Okuda, Jouji Takada and Hiromi Hamada

Department of Surgery, Nikko Memorial Hospital

Hepatic resection in nonalcoholic steatohepatitis (NASH) requires a cautious preoperative evaluation and appropriate resection due to possibly decreased hepatic function reserve caused by NASH. Our case involved a 71-year-old woman with elevated hepatobiliary enzyme and diagnosed with hepatic hilar duct cancer extending from the confluence of the right and left hepatic ducts to the right hepatic duct. Her history of diabetes, hyperlipidemia, and fatty liver led us to suspect NASH. Hepatic function reserve was considered sufficient because ICGR15 and HH15 and LHL15 of ^99mTc-GSA scintigraphy were normal. An increased estimated hepatic function reserve of 39.1% was obtained by ^99mTc-GSA scintigraphy following portal vein embolization, and extended right lobectomy was done. No signs of postoperative hepatic failure were seen and the patient has progressed well. Histopathological findings confirmed a diagnosis of NASH, suggesting that surgical methods and evaluating hepatic function reserve as in cases of liver cirrhosis which center around ICGR15 and ^99mTc-GCA scintigraphy are useful in cases of NASH.

Key words
NASH, major hepatectomy, cholangiocarcinoma

Reprint requests
Seiji Oguro Department of Surgery, National Cancer Center Hospital
5-1-1 Tsukiji, Chuo-ku, 104-0045 JAPAN

Accepted
December 17, 2008

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