RESUMO
PURPOSE: A major hepatobiliary resection (MHBR), liver resection of more than one lobe, has been recommended by some surgeons for advanced carcinomas (Ca) of the gallbladder (GB) and the hilar bile duct (HBD). However, high operative mortality and morbidity have been reported and its survival benefit has not been clearly documented. METHODS: We report the results of MHBR for such tumors to determine the safety and the effectiveness of this operation, which has been performed for GB Ca invading the right hepatic pedicle or liver bed by 2 cm or more and for HBD Ca of Bismuth type III or IV. The cases of fifty consecutive cases who received MHBR for GB Ca (n=11) or HBD Ca (n=39) during a 5 year-period were reviewed. RESULTS: Thirty right-sided and 20 left-sided hepatectomies were performed. There was no operative or hospital death. Minor and major complications developed in 64% of the cases. All the complications improved with conservative management, except two in which re operations were required, one due to portal vein thrombosis and the other to bleeding of the retro peritoneal dissection site. No specific factors were associated with the high complication rate. The long-term outcome of HBD Ca was better than that of GB Ca. In HBD Ca, differentiated cancer and less transfusion were associated with a better prognosis. CONCLUSION: MHBR was conducted with acceptable morbidity and no mortality. In terms of the long-term outcome, MHBR is recommended for HBD Ca whereas it should be considered more carefully for GB Ca.
Assuntos
Ductos Biliares , Sistema Biliar , Bismuto , Vesícula Biliar , Hemorragia , Hepatectomia , Fígado , Mortalidade , Prognóstico , Trombose VenosaRESUMO
PURPOSE: A major hepatobiliary resection (MHBR), liver resection of more than one lobe, has been recommended by some surgeons for advanced carcinomas (Ca) of the gallbladder (GB) and the hilar bile duct (HBD). However, high operative mortality and morbidity have been reported and its survival benefit has not been clearly documented. METHODS: We report the results of MHBR for such tumors to determine the safety and the effectiveness of this operation, which has been performed for GB Ca invading the right hepatic pedicle or liver bed by 2 cm or more and for HBD Ca of Bismuth type III or IV. The cases of fifty consecutive cases who received MHBR for GB Ca (n=11) or HBD Ca (n=39) during a 5 year-period were reviewed. RESULTS: Thirty right-sided and 20 left-sided hepatectomies were performed. There was no operative or hospital death. Minor and major complications developed in 64% of the cases. All the complications improved with conservative management, except two in which re operations were required, one due to portal vein thrombosis and the other to bleeding of the retro peritoneal dissection site. No specific factors were associated with the high complication rate. The long-term outcome of HBD Ca was better than that of GB Ca. In HBD Ca, differentiated cancer and less transfusion were associated with a better prognosis. CONCLUSION: MHBR was conducted with acceptable morbidity and no mortality. In terms of the long-term outcome, MHBR is recommended for HBD Ca whereas it should be considered more carefully for GB Ca.