Laparoscopic resections for Klatskin tumour – three cases
EAES Academy. Bezsilla J. 07/05/22; 363052; P096
János Bezsilla
Contributions
Contributions
Abstract
Surgical management of hilar cholangiocarcinoma remains the only treatment option with curative intent and potential influence on overall survival.
In our case series, we describe complete laparoscopic resection of Klatskin’s tumour which consists of radical extrahepatic biliary resection with lymphadenectomy and in selected cases with left hepatectomy followed by laparoscopic intracorporeal biliary reconstruction with Roux-en-Y hepaticojejunostomy.
Two women and a man aged 45 (28-59) years presented with obstructive jaundice without other symptoms. Their CEA, Ca-125, AFP values were normal and Ca 19-9 was elevated in only one case. CT, ERCP and MRCP showed Bismuth type II., III.b. and IV. neoplastic lesions, with vascular involvement in the third patient.
Diagnostic laparoscopy was performed with ultrasonography. Cholecystectomy with resection of the extrahepatic biliary ductal system and the transection of prestenotic central even the right biliary branch/branches was done. Hepatoduodenal lymphadenectomy was performed and in two cases left branches of the hepatic artery and the portal vein were clipped. In one case segment II-IV was removed without caudate lobectomy and in another case segment I-IV. In these operations left hepatic vein was clipped. After removal the specimen through a left upper quadrant minilaparotomy and construction a Roux-en-Y loop, bilioenteric anastomosis was performed using total laparoscopic procedure. In Bismuth type IV. case we created two separate bilioenteric anastomoses.
The operation time was 310 (255-440) minutes with intraoperative blood loss of 200 ml. The pathologic result showed one pT2 pN0 and two pT2 pN1 primary hilar cholangiocarcinomas with all resected margins free of tumour.
The postoperative hospital stay was uneventful and patients were discharged on day 13 (12-14).
Patients had adjuvant chemotherapy and were well at 3-month visit with normal results of liver function test and MRCP.
Laparoscopic resection and bilioenteric reconstruction are feasible surgical approaches in selected patients with hilar cholangiocarcinoma.
In our case series, we describe complete laparoscopic resection of Klatskin’s tumour which consists of radical extrahepatic biliary resection with lymphadenectomy and in selected cases with left hepatectomy followed by laparoscopic intracorporeal biliary reconstruction with Roux-en-Y hepaticojejunostomy.
Two women and a man aged 45 (28-59) years presented with obstructive jaundice without other symptoms. Their CEA, Ca-125, AFP values were normal and Ca 19-9 was elevated in only one case. CT, ERCP and MRCP showed Bismuth type II., III.b. and IV. neoplastic lesions, with vascular involvement in the third patient.
Diagnostic laparoscopy was performed with ultrasonography. Cholecystectomy with resection of the extrahepatic biliary ductal system and the transection of prestenotic central even the right biliary branch/branches was done. Hepatoduodenal lymphadenectomy was performed and in two cases left branches of the hepatic artery and the portal vein were clipped. In one case segment II-IV was removed without caudate lobectomy and in another case segment I-IV. In these operations left hepatic vein was clipped. After removal the specimen through a left upper quadrant minilaparotomy and construction a Roux-en-Y loop, bilioenteric anastomosis was performed using total laparoscopic procedure. In Bismuth type IV. case we created two separate bilioenteric anastomoses.
The operation time was 310 (255-440) minutes with intraoperative blood loss of 200 ml. The pathologic result showed one pT2 pN0 and two pT2 pN1 primary hilar cholangiocarcinomas with all resected margins free of tumour.
The postoperative hospital stay was uneventful and patients were discharged on day 13 (12-14).
Patients had adjuvant chemotherapy and were well at 3-month visit with normal results of liver function test and MRCP.
Laparoscopic resection and bilioenteric reconstruction are feasible surgical approaches in selected patients with hilar cholangiocarcinoma.
Surgical management of hilar cholangiocarcinoma remains the only treatment option with curative intent and potential influence on overall survival.
In our case series, we describe complete laparoscopic resection of Klatskin’s tumour which consists of radical extrahepatic biliary resection with lymphadenectomy and in selected cases with left hepatectomy followed by laparoscopic intracorporeal biliary reconstruction with Roux-en-Y hepaticojejunostomy.
Two women and a man aged 45 (28-59) years presented with obstructive jaundice without other symptoms. Their CEA, Ca-125, AFP values were normal and Ca 19-9 was elevated in only one case. CT, ERCP and MRCP showed Bismuth type II., III.b. and IV. neoplastic lesions, with vascular involvement in the third patient.
Diagnostic laparoscopy was performed with ultrasonography. Cholecystectomy with resection of the extrahepatic biliary ductal system and the transection of prestenotic central even the right biliary branch/branches was done. Hepatoduodenal lymphadenectomy was performed and in two cases left branches of the hepatic artery and the portal vein were clipped. In one case segment II-IV was removed without caudate lobectomy and in another case segment I-IV. In these operations left hepatic vein was clipped. After removal the specimen through a left upper quadrant minilaparotomy and construction a Roux-en-Y loop, bilioenteric anastomosis was performed using total laparoscopic procedure. In Bismuth type IV. case we created two separate bilioenteric anastomoses.
The operation time was 310 (255-440) minutes with intraoperative blood loss of 200 ml. The pathologic result showed one pT2 pN0 and two pT2 pN1 primary hilar cholangiocarcinomas with all resected margins free of tumour.
The postoperative hospital stay was uneventful and patients were discharged on day 13 (12-14).
Patients had adjuvant chemotherapy and were well at 3-month visit with normal results of liver function test and MRCP.
Laparoscopic resection and bilioenteric reconstruction are feasible surgical approaches in selected patients with hilar cholangiocarcinoma.
In our case series, we describe complete laparoscopic resection of Klatskin’s tumour which consists of radical extrahepatic biliary resection with lymphadenectomy and in selected cases with left hepatectomy followed by laparoscopic intracorporeal biliary reconstruction with Roux-en-Y hepaticojejunostomy.
Two women and a man aged 45 (28-59) years presented with obstructive jaundice without other symptoms. Their CEA, Ca-125, AFP values were normal and Ca 19-9 was elevated in only one case. CT, ERCP and MRCP showed Bismuth type II., III.b. and IV. neoplastic lesions, with vascular involvement in the third patient.
Diagnostic laparoscopy was performed with ultrasonography. Cholecystectomy with resection of the extrahepatic biliary ductal system and the transection of prestenotic central even the right biliary branch/branches was done. Hepatoduodenal lymphadenectomy was performed and in two cases left branches of the hepatic artery and the portal vein were clipped. In one case segment II-IV was removed without caudate lobectomy and in another case segment I-IV. In these operations left hepatic vein was clipped. After removal the specimen through a left upper quadrant minilaparotomy and construction a Roux-en-Y loop, bilioenteric anastomosis was performed using total laparoscopic procedure. In Bismuth type IV. case we created two separate bilioenteric anastomoses.
The operation time was 310 (255-440) minutes with intraoperative blood loss of 200 ml. The pathologic result showed one pT2 pN0 and two pT2 pN1 primary hilar cholangiocarcinomas with all resected margins free of tumour.
The postoperative hospital stay was uneventful and patients were discharged on day 13 (12-14).
Patients had adjuvant chemotherapy and were well at 3-month visit with normal results of liver function test and MRCP.
Laparoscopic resection and bilioenteric reconstruction are feasible surgical approaches in selected patients with hilar cholangiocarcinoma.
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