Primary experience of laparoscopic radical resection of Bismuth Ⅲ and Ⅳ perihilar cholangiocarcinoma:with a report of 10 patients
Objective:To summarize the feasibility and safety of laparoscopic radical resection of Bismuth types Ⅲ and Ⅳ peri-hilar cholangiocarcinoma.Methods:Clinical data of 10 patients with Bismuth types Ⅲ and Ⅳ perihilar cholangiocarcinoma who under-went laparoscopic radical surgery from Dec.2017 to Apr.2021 were retrospectively analyzed.Results:This study included 6 males and 4 females.According to preoperative image data,Bismuth types Ⅲa,Ⅲb,Ⅳ were found in 1,7 and 2 patients,respectively.All surgeries were completed successfully.Right hemihepatectomy and biliary-intestinal anastomosis was performed in 1 patient,left hemihepatectomy and biliary-intestinal anastomosis was performed in 6 patients,left hemihepatectomy and bilioenteric anastomosis and repair of the right anterior branch of the right hepatic artery was performed in 1 patient,extended left hemihepatectomy and biliary-intestinal anastomosis was performed in 1 patient,and periportal hepatectomy and biliary-intestinal anastomosis was performed in 1 patient.Caudate lobectomy was performed simultaneously in all patients during surgery.The mean operation time was(623.5±162.1)min,and mean intraoperative blood loss was(605.0±457.3)mL.There were 2 postoperative complications,including 1 grade B biliary leakage with fever and 1 hypoproteinemia with anemia.There were no unplanned reoperation or death patients in perioperative period.Postoperative pathologi-cal result revealed bile duct adenocarcinoma in 9 patients and invasive intracapsular papillary carcinoma in 1 patient.R0 resection rate was 90％.According to the AJCC8th edition staging criteria for perihilar cholangiocarcinoma,there were3 cases of stageⅠ,3 cases of stage Ⅱ,1 case of stage ⅢB,2 cases of stage ⅢC,and 1 case of stageⅣA.Up to Apr.2023,1 of 10 patients was lost to follow-up,with a follow-up time of 7 to 45 months and a median follow-up time of 12 months.6 patients had tumor recurrence and metastasis after surgery,and 5 of them died.Conclusions:Laparoscopic radical resection of Bismuth Ⅲ and Ⅳ perihilar cholangiocarcinoma remains extremely challenging,but it is generally safe and feasible for surgeons with extensive laparoscopic experience,but patients should be rigorously screened preoperatively.
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