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KMID : 0371320000580040551
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Journal of the Korean Surgical Society
2000 Volume.58 No. 4 p.551 ~ p.559
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Clinical Outcome of Major Hepatobiliary Resections for Malignant Tumor of the Extrahepatic Biliary Tree
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장진영/Jin-Young Jang
김선회/박상재/허규희/서경석/이건욱/박용현/Sun-Whe Kim/Sang-Jae Park/Kyu Hee Her/Kyung-Suk Suh/Kuhn Uk Lee/Yong-Hyun Park
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Abstract
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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
reoperations were required, one due to portal vein thrombosis and the other to bleeding of the retroperitoneal 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.
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KEYWORD
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