Laparoscopic Cholangiotomy for Radical Excision of Upper Cholangiocarcinoma / 中国微创外科杂志

ABSTRACT

Objective To evaluate the feasibility of laparoscopic cholangiotomy for radical excision of upper cholangiocarcinoma. Methods Four trocars were placed at the umbilical area, right upper and lower abdomen, and below the xiphoid. A 3 cm incision was made at the left upper abdomen for Roux-en-Y jejunojejunostomy. The gallbladder, inferior segment of the left medial liver, and the middle-upper segment of the bile duct were resected. And then the tumor and the adjacent 1 cm bile duct were excised. Afterwards, the proper hepatic artery, portal vein, and the surrounding connective tissues and lymph nodes were removed. Finally, the bile-jejunum Roux-en-Y anastomosis was performed. Results The hepatic duct bifurcation was involved by the cholangiocarcinoma in all the 4 cases. The diameter of the tumor was 1-1.5 cm. The resection of the inferior segment of the left medial liver and middle and upper segments of the bile duct, and dissection of the lymph nodes at the hepatic porta were completed successfully. The operation was accomplished in all the cases with an operation time of 270, 255, 270, and 230 mins, and the intraoperative blood loss was 500, 400, 300, and 400 ml, respectively. Postoperative pathological examination showed highly differentiated adenocarcinoma in all the cases. Cases 2 and 3 developed bile leakage after the operation and were cured 20 or 15 days later. In all the cases, the jaundice disappeared after the operation. Their appetite recovered, and the body weight was increased by 3, 3.5, 2, and 2 kg, respectively. Conclusions Upper cholangiocarcinoma can be radically excised by using laparoscopy. The resection of cholangiocarcinoma and part of liver tissues, dissection of surrounding connective tissues and lymph nodes, and bile duct reconstruction can be accomplished under a laparoscope. Thus,we consider that laparoscopic cholangiotomy is feasible for radical excision of upper cholangiocarcinoma.