Skip to main content
NCBI home page
Annals of Surgery logoLink to Annals of Surgery
. 1976 Jul;184(1):68–73. doi: 10.1097/00000658-197607000-00012

Surgical management of carcinoma of the junction of the main hepatic ducts.

J G Fortner, B O Kallum, D K Kim
PMCID: PMC1344310  PMID: 59580

Abstract

Twenty-six patients are reviewed who had primary carcinomas involving the junction of the hepatic ducts. The majority had had an initial procedure of palliative biliary diversion elsewhere and were referred for further treatment. In three cases, en bloc resection of the tumor with total hepatectomy and orthotopic liver transplantation were performed. All tumor growth was encompassed in each case, but within 4 months all succumbed as a result of allograft rejection. Auxiliary (heterotopic) liver transplantation was performed in another patient because of recurrent disease after previous left hepatic resection in continuity with a hilar duct lesion. Five patients underwent hepatic lobectomy with en bloc resection of the hepatic duct junction. When adequate tumor excision was not feasible, biliary diversion could provide good palliation in some instances for extended periods of time. This is demonstrated by one patient who lived for 4 years and 4 months after the initial operation. In the meantime, the patient underwent 6 subsequent procedures of dilating of constricted bile ducts and tube cannulation of the biliary tree. Biliary diversion was achieved in 4 cases by intrahepatic cholangiojejunostomy. One of these patients, who is on chemotherapy, is asymptomatic one year after surgery.

Full text

PDF
68

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ALTEMEIER W. A., GALL E. A., ZINNINGER M. M., HOXWORTH P. I. Sclerosing carcinoma of the major intrahepatic bile ducts. AMA Arch Surg. 1957 Sep;75(3):450–461. doi: 10.1001/archsurg.1957.01280150140015. [DOI] [PubMed] [Google Scholar]
  2. Alexandre J. H., Petite J. P., Germain M., Chevalley J., Poilleux F. Chirurgie d'exérèse dans les cancers des canaux biliaires intra-hépatiques. Chirurgie. 1973 May 2;99(6):356–363. [PubMed] [Google Scholar]
  3. Cady B., Fortner J. G. Surgical resection of intrahepatic bile duct cancer. Am J Surg. 1969 Jul;118(1):104–107. doi: 10.1016/0002-9610(69)90103-2. [DOI] [PubMed] [Google Scholar]
  4. Fortner J. G., Beattie E. J., Jr, Shiu M. H., Kawano N., Howland W. S. Orthotopic and heterotopic liver homografts in man. Ann Surg. 1970 Jul;172(1):23–32. [PMC free article] [PubMed] [Google Scholar]
  5. Fortner J. G., Kinne D. W., Shiu M. H., Howland W. S., Kim D. K., Castro E. B., Yeh S. D., Benua R. S., Krumins S. Clinical liver heterotopic (auxiliary) transplantation. Surgery. 1973 Nov;74(5):739–751. [PubMed] [Google Scholar]
  6. Fortner J. G., Shiu M. H., Kinne D. W., Kim D. K., Castro E. B., Watson R. C., Howland W. S., Beattie E. J., Jr Major hepatic resection using vascular isolation and hypothermic perfusion. Ann Surg. 1974 Oct;180(4):644–652. doi: 10.1097/00000658-197410000-00030. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. HAYNES C. D., GINGRICH G. W., THOROUGHMAN J. C. CARCINOMA OF THE BILE DUCT: DIAGNOSIS AND TREATMENT. Am Surg. 1964 Sep;30:578–582. [PubMed] [Google Scholar]
  8. KLATSKIN G. ADENOCARCINOMA OF THE HEPATIC DUCT AT ITS BIFURCATION WITHIN THE PORTA HEPATIS. AN UNUSUAL TUMOR WITH DISTINCTIVE CLINICAL AND PATHOLOGICAL FEATURES. Am J Med. 1965 Feb;38:241–256. doi: 10.1016/0002-9343(65)90178-6. [DOI] [PubMed] [Google Scholar]
  9. Kelly K. A. Successful resection of adenocarcinoma of junction of right, left, and common hepatic biliary ducts. Report of case. Mayo Clin Proc. 1972 Jan;47(1):48–50. [PubMed] [Google Scholar]
  10. Klippel A. P., Shaw R. B. Carcinoma of the common bile duct. Report of a case of successful resection. Arch Surg. 1972 Jan;104(1):102–103. doi: 10.1001/archsurg.1972.04180010096025. [DOI] [PubMed] [Google Scholar]
  11. LIPPMAN H. N., LONGMIRE W. P., Jr Intrahepatic cholangiojejunostomy; an operation for biliary obstruction. Surg Clin North Am. 1956 Aug;:849–863. [PubMed] [Google Scholar]
  12. Longmire W. P., McArthur M. S., Bastounis E. A., Hiatt J. Carcinoma of the extrahepatic biliary tract. Ann Surg. 1973 Sep;178(3):333–345. doi: 10.1097/00000658-197309000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Praderi R. C. Twelve years' experience with transhepatic intubation. Ann Surg. 1974 Jun;179(6):937–940. doi: 10.1097/00000658-197406000-00021. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. QUATTLEBAUM J. K., QUATTLEBAUM J. K., Jr MALIGNANT OBSTRUCTION OF THE MAJOR HEPATIC DUCTS. Ann Surg. 1965 Jun;161:876–889. doi: 10.1097/00000658-196506000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Ragins H., Diamond A., Meng C. H. Intrahepatic cholangiojejunostomy in the management of malignant biliary obstruction. Surg Gynecol Obstet. 1973 Jan;136(1):27–32. [PubMed] [Google Scholar]
  16. SMITH R. HEPATICOJEJUNOSTOMY WITH TRANSHEPATIC INTUBATION: A TECHNIQUE FOR VERY HIGH STRICTURES OF THE HEPATIC DUCTS. Br J Surg. 1964 Mar;51:186–194. doi: 10.1002/bjs.1800510307. [DOI] [PubMed] [Google Scholar]
  17. Sullivan R. C., Faris T. D. Hepaticojejunostomy. Modified longmire operation for bile duct carcinoma. Am J Surg. 1967 Nov;114(5):722–725. doi: 10.1016/0002-9610(67)90136-5. [DOI] [PubMed] [Google Scholar]
  18. Terblanche J., Saunders S. J., Louw J. H. Prolonged palliation in carcinoma of the man hepatic duct junction. Surgery. 1972 May;71(5):720–731. [PubMed] [Google Scholar]
  19. Warren K. W., Mountain J. C., Lloyd-Jones W. Malignant tumours of the bile-ducts. Br J Surg. 1972 Jul;59(7):501–505. doi: 10.1002/bjs.1800590702. [DOI] [PubMed] [Google Scholar]
  20. Whelton M. J., Petrelli M., George P., Young W. B., Sherlock S. Carcinoma at the junction of the main hepatic ducts. Q J Med. 1969 Apr;38(150):211–230. [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES