A Clinical Review for Peripheral Cholangiocarcinoma

PURPOSE: A peripheral cholangiocarcinoma, which has been defined as a primary adenocarcinoma from the intrahepatic bile ducts proximal to the second-order branch of the main hepatic duct, has a poor prognosis against various treatment modalities. We analyzed the clinical characteristics of peripheral cholangiocarcinomas and evaluated the outcomes of surgical treatment. METHODS: A retrospective study of 46 peripheral cholangiocarcinoma cases for which surgical exploration was performed at the Asan Medical Center over a 7-year period was conducted. RESULTS: Clinical manifestations on admission were abdominal pain including epigastric pain (89%), weight loss (33%), fever (28%), jaundice (24%), a palpable mass (20%), and general weakness (11%). Associated diseases were hepatolithiasis in 54.3% and clonorchiasis in 9%. Positive findings showing a hepatic mass were found in 75% of the cases by using computed tomography and in 52% of the cases by using ultrasonography. Angiographic hypervascularity was seen in 17.4% of the cases and hypovascularity in 82.6%. The gross morphologic types of the peripheral cholangiocarcinomas were mass-forming (74%), periductal infiltrative (17%), and intraductal growing (17%). Nodal metastasis was found in 48% of the patients. The location of the peripheral cholangiocarcinoma was the left lobe (54%), the right lobe (35%), the caudate lobe (4%) and both lobes (6%). Of the 46 patients, 29 underwent a hepatic resection from the lateral segmentectomy to the right trisegmentectomy, and 17 cases underwent palliative surgery. The 1-year and 2-year survival rates of the hepatic-resection cases were 62% and 50%, respectively. The 1-year and 2-year survival rates of the palliative-surgery cases were 32% and 21%, respectively univariate analysis showed that tumor size, growth pattern, nodal metastasis, the extent of the hepatic resection, and node dissection did not significantly affect the survival of the patients. CONCLUSIONS: Careful preoperative evaluation using computed tomography, ultrasonography, and angiography and a study of tumor markers for the possibility of a peripheral cholangiocarcinoma is necessary in risk groups with hepatolithiasis or clonorchiasis. Hepatic resection should be used in hepatolithiasis patients to improve the chance of survival.

Clinical Outcome of Microsurgical Multiple Renal Artery Reconstruction in Renal Transplantation / 대한이식학회지

The incidence of multiple renal arteries has been reported as 18~30% in cadaveric organ procurement. There has been many cases in which the reconstruction of renal arteries were needed because of the use of donor kidney with multiple renal arteries or the injuries of renal arteries during organ harvest. We studied on the graft function and survival following reconstruction of multiple renal arteries. Between January 1990 and December 1996, we have performed 500 renal transplants, among which 65 cases(13%) of the multiple donor renal arteries were encountered either from the multiple number of donor renal artery itself or from the injury of renal artery during harvest. The remaining 435 cases had a single donor renal artery. The type of reconstruction under the microscope and graft material that we have used were illustrated as follows; ligation of a polar artery or two polar arteries in 8 cases, end to side anastomosis between a polar artery and main renal artery in 26 cases, side to side anastomosis between a polar artery and main renal artery in 12 cases, separate anastomosis of two renal arteries to external iliac or internal iliac artery in 2 cases, side to side anastomosis between two polar arteries then end to side anastomosis between reconstructed polar artery and a main renal artery in 3 cases, Carrel aortic patch in 3 cases, and interposition graft in 10 cases using inferior epigastric artery in 6 cases, branched internal iliac artery in 3 cases, and saphenous vein in 1 case. In the kidneys with reconstructed multiple renal arteries, the rate of vascular and urologic complications such as bleeding, stenosis, thrombosis of anastomotic site, ureteral obstruction and urinary leakage did not show any difference with the single renal artery group. And there was no difference in 1-year graft survival between the two groups. We think that the donor kidney with reconstructed multiple renal arteries does not have any negative impact on graft survival resulting in same early and late vascular and urologic complications as a single renal artery group when proper revascularization can be performed.

Splenic True Cyst

Non-parasitic true cyst of spleen is one of the rare disease entities. It is thought that they usually develop as a result of abnormality in the development of the spleen and spontaneous or traumatic hemorrhage of the spleen with subsequent organization and liquefaction. It is often presented with asymptomatic abdominal mass, or symptom of compressive effect on a neighboring organ. After corrective differential diagnosis using USG or CT, it can be treated with splenectomy, totally or partially, according to its size and location. We report a case of true splenic cyst in 22-year old female patient who was treated with splenectomy.