A left hemihepatectomy and a right hepatic artery reconstruction involving the left hepatic artery for cholangiocellular carcinoma

Abstract

A 60-year-old male with gastric cancer had a distal gastrectomy and cholecystectomy ; 9 months later a 1-cm diameter mass with an associated dilatation of the intrahepatic bile duct located at the left lobe of the liver was noted on abdominal CT. The patient was diagnosed as either having a liver metastasis from the gastric cancer or cholangiocellular carcinoma ; a left hemihepatectomy was planned for February 2005. At laparotomy, the right hepatic artery was found to be narrowed at the ligated portion of the cystic duct ; no pulsation was noted. Therefore, it was likely that the right hepatic artery had been injured during the last operation. It was necessary to rebuild the right hepatic artery since there was no arterial blood flow in the liver when the left hepatic artery was clamped. The right hepatic artery was reconstructed and attached to the remnant of the left hepatic artery using an interpositional technique involving the saphenous vein. After confirming that the right hepatic arterial flow was adequate a left hemihepatectomy was done. The patient's postoperative course was uneventful, and he was discharged 13 days after surgery. On histology, the patient's tumor was diagnosed as a cholangiocellular carcinoma.