Total Laparoscopic Resection of Hilar Cholangiocarcinoma Type 3b: Applying a Parachute Technique for Hepaticojejunostomy
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ORIGINAL ARTICLE – HEPATOBILIARY TUMORS
Total Laparoscopic Resection of Hilar Cholangiocarcinoma Type 3b: Applying a Parachute Technique for Hepaticojejunostomy Robert Sucher, MD, Uwe Scheuermann, MD, and Daniel Seehofer, MD Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University Clinic Leipzig, Leipzig, Germany
ABSTRACT Background. Laparoscopic liver resection for perihilar cholangiocarcinoma (pCCA) is still in its infancy. The biliary-enteric reconstruction represents one of the most delicate parts of this minimally invasive procedure. Methods. In this study, a 78-year old woman with perihilar cholangiocarcinoma (pCCA) type 3b underwent a hepaticojejunostomy performed by a parachute technique. Results. The operation, performed totally by minimally invasive resections, was completed in 386 min, with a blood loss of less than 400 ml and no transfusion requirements. Two intraluminal stents were placed during the hepaticojenunostomy for splinting of the biliary-enteric anastomosis. The patient required prolonged antibiotic treatment for postoperative cholangitis and finally was discharged on postoperative day 15. The histopathologic grading displayed a G 2–3 adenocarcinoma, pT3 pN0, M0, L1, V1, pN1, UICC IIIc R0, and the patient was referred to adjuvant chemotherapy. Conclusion. Resections of pCCAs, performed totally by minimally invasive techniques, may be feasible and safe for a selected group of patients. With this approach, a running-suture hepaticojejunostomy using the parachute
Robert Sucher and Uwe Scheuermann have contributed equally to this work and share first authorship
Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-020-09175-1) contains supplementary material, which is available to authorized users. Ó The Author(s) 2020 First Received: 4 June 2020 Accepted: 8 September 2020 R. Sucher, MD e-mail: [email protected]
technique represents a worthwhile strategy for biliary-enteric reconstruction.
Perihilar cholangiocarcinomas (pCCA) Bismuth Corlette types 3a and 3b require radical lymphadenectomy, resection of the respective hemiliver, extrahepatic bile duct resection, and biliary reconstruction by hepaticojejunostomy to achieve long-term patient survival.1 Although technically highly demanding, all the aforementioned critical steps of cholangiocarcinoma (CCA) surgery recently have been performed totally by minimally invasive techniques for selected groups of patients.2–4 Furthermore, a recent analysis of patients with pCCA treated in one of the leading European centers for laparoscopic liver surgery showed no oncologic inferiority of a laparoscopic resection, which might have been a major concern of surgeons preparing for the final step toward minimally invasiveness in pCCA surgery.5 However, from the expert’s point of view, minimally invasive pCCA surgery remains in an exploratory phase, with the conversion rate of 18.8% reaching the rate generally reported for major laparoscopic hepatectomies.6 Nevertheless,
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