Abstract
Resection of the extrahepatic bile duct, central hepatic resection or hilar hepatic resection is included in limited surgery for carcinoma of proximal bile duct. Limited surgery is ordinarily performed with dissection of the regional lymph nodes and resction of the caudate lobe. This limited surgery is applied for patients who are Type 1 or Type 2 in Bismuth's classification of the located portion of tumor, macroscopically papillary type or nodular type without invation of serosa and liver, lymph node metastasis and cancer that is histologically limited to the mucosa and fibromuscularis layer. Limited surgery includes simple cholecystectomy, full thickness cholecystectomy, wedge resection of the liver or S4a5 segmental resection of the liver for carcinoma of the gallbladder. Dissection of the regional lymph nodes and/or resection of the bile duct are undertaken according to the extent of spreading with this limited operation. First, in cases of m cancer, simple cholecystectomy can be applied. Second, in cases of pm cancer, full thickness cholecystectomy or wedge resection of the liver with R2 dissection of the lymph nodes can be applied. Third, in cases of ss cancer, wedge resection of the liver or S4a5 segmental resection of the liver with resection of the bile duct and R2 dissection of the lymph nodes including paraaaortic lymph nodes can be applied.
