Abstracts
1998 Digestive Disease Week

#1054

S4B+S5 RESECTION WITH TOTAL CAUDATE LOBECTOMY USING TAJ MAHAL LIVER INCISION FOR CARCINOMA OF THE BILIARY TRACT. Y.Kawarada, M.Tabata, K.Yamagiwa, H.Taoka, S.Isaji, H.Yokoi, Y. Ogura and T.Noguchi. First Dept. of Surg., Mie Univ School of Medicine, Japan.

Recently we have been performing total resection of the caudate lobe plus S4b+S5 resection by using a dome-like dissection along the root of the middle hepatic vein at the pinnacle (Taj Mahal liver incision:Fig.) for carcinoma of the biliary tract, and we describe the procedure and outcome below. [Advantages of this procedure] 1) Total caudate lobe resection, including S9 can be performed easily. 2) The cut surface of the liver is large, and it is possible to perform intrahepatic jejunostomy easily with a good field of vision. [Indications] 1) Hilar bile duct carcinoma. There is a high rate of hilar liver parenchyma and caudate lobe invasion, and they must be resected. This procedure is indicated in cases in which extended liver resection is impossible. The dissection limits of this procedure are, on the left side, the B2, B3 bifurcation at the right margin of the umbilical portion of the portal vein, and the B6, B7 bifurcation of the right posterior branch. It could also be described as a reduced form of extended right lobectomy and extended left lobectomy. 2) Gallbladder carcinoma: This procedure is indicated to ensure an adequate surgical margin and erradicate transvenous liver metastasis, particularly in pT2 cases. Hilar and caudate lobe invasion also occur in liver-bed-type gallbladder carcinoma, and bile duct resection and caudate lobe resection are necessary to be curative. [Surgical outcome] This procedure was performed in 4 cases of hilar bile duct carcinoma and 4 cases of gallbladder carcinoma. Curative resection was possible in every case, and all of the patients are alive and recurrence-free from 3 to 25 months postoperatively. [Conclusion] This procedure, in addition to preserving liver function, provides a wide field of vision, and facilitates reconstruction of multiple intrahepatic bile ducts. Thus, it can be said to be a curative operation not only in high risk cases, but in hilar bile duct carcinoma with slight extension on the hepatic side and in gallbladder carcinoma up to pT2.

Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.