Limited Hepatic Resections in Carcinomas with Hilar Invasion Due to Impaired Liver Function: Report of Two Cases
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Extent of hepatectomy for liver tumor is often limited in case the patient has an impaired liver function. We report here our experience in 2 patients with carcinoma involving hilar bile duct who have undergone limited liver resection. <I>Case 1</I>. 76-year-old male, who have had hepatitis C cirrhosis, showed in segment 4 a hepatocellular carcinoma of 4 cm in diameter. The tumor involved the right and left main hepatic ducts and obstructive jaundice was progressed. The patient had liver and respiratory dysfunctions and, therefore, limited resection of lower segments 4 and 5 and resection of hilar hepatic duct and the common bile duct were performed to avoid postoperative morbidity including liver failure. Histopathological diagnosis showed the tumor invasion and thrombus in major hepatic ducts and severe fibrosis in non-cancerous liver. In spite of long-term ascites, gastrointestinal bleeding or sepsis, liver functions were relatively maintained and the patient was discharged 3 months after surgery. <I>Case 2</I>. 64-year-old male, who had obstructive jaundice, showed a carcinoma in the common hepatic duct. After biliary drainage, however, liver dysfunction was not improved for a long period. The common hepatic duct including gall bladder was resected, and superficial spreading of the tumor to the right and left main bile duct was confirmed by the pathologic examination. Therefore, limited hepatic resection of lower segments 4 and 5 and resection of main hepatic ducts were additionally undergone. Although bile leakage of left hepatic duct occurred for 1 month, hepatic function was reserved and the patient was discharged 2 months after surgery. In conclusion, hepatic resection may be limited even in patient with carcinoma invading hilar bile duct in case the hepatic functional reserve is poor for major hepatectomy.
- 長崎大学医学部の論文
長崎大学医学部 | 論文
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