Extended High Hilar Resection And Enlarged Hepatic Portal Enterostomy In The Treatment Of Hilar Cholangiocarcinoma

Background Tertiary biliary radical reconstruction and biliary-enteric continuity restoration limits the radical resection of hilar cholangiocarcinoma,because there are multiple biliary radicals in the cut surface of liver and some of them are smaller than 1-2 mm.Enlarged anastomosis orifice might delay the jaundice related to local recurrence which is the main cause of long-term morbidity and mortality.We proposed extended high hilar resection and enlarged hepatic portal parenchyma-enterostomy for hilar cholangiocarcinoma.Methods Fifty-six patients of hepatic hilar cholangiocarcinoma were referred for surgical treatment from March 2016 to March 2018.Duplex ultrasonography(US),computed tomography(CT)and/or magnetic resonance cholangiopancreatography(MRCP)were applied to evaluate the range of invasion and distant metastasis of tumours.Percutaneous transhepatic biliary drainage(PTCD)and bile refusion were performed on patients with compromised health conditions,and a total bilirubin(TB)level higher than 400 ?mol/L.Results Hepatic hilar resection and portal parenchyma-enterostomy was performed on 51 patients,Five to twelve biliary radicles were exposed.Eleven patients underwent right hepatic artery resection and partial resection of portal vein was performed on 4 patients.Combined right/or left lobectomy with caudate lobectomy was carried out on 16 patients.The levels of serum aspartate aminotransferase(AST)and alanine aminotransferase(ALT)decreased significantly.Icterus was significantly improved and the serum TB level decreased postoperatively.Hepatic abscess occurred in 3 patients.One patients with bile leakage died of pneumonia 2 months post operation.The remaining patients recovered three months after operation to a life close to 2normal conditions.Conclusion Extended high hilar resection and enlarged hepatic portal enterostomy was applied for the treatment of hilar cholangiocarcinoma patients and it had a positive outcome in many patients.