Factors of the selection of right-sided or left-sided hepatectomy for perihilar cholangiocacrcinoma

Abstract

Surgical procedures for perihilar cholangiocacrcinoma are right-sided hepatectomy (right hepatectomy and right trisectionectomy) and left-sided hepatectomy (left hepatectomy and left trisectionectomy). Important factors for the selection are precise evaluation of the longitudinal tumor extent and vascular invasion of perihilar cholangiocacrcinoma as well as monitoring future liver remnant function. MDCT and 3D-CT cholangiography are valuable for evaluating tumor extent and invasion, and the diagnostic accuracy is reported to be about 80%. Tumor mapping biopsy is useful for detection of tumor extent, but there remains a problem of false-positive results. Progression of radiological imaging evaluation of vascular invasion of perihilar cholangiocacrcinoma resulted in increasing numbers of combined vascular resection. Future liver remnant function should be evaluated by indocyanine green (ICG) clearance. Remnant liver volume >40% and value of remnant liver ICG K >0.05 are important for safe hepatectomy. 99mTc-GSA SPECT/CT fusion imaging and biopsy of remnant liver are supporting tools for selection of surgical method.