Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2024; 16(7): 2167-2174
Published online Jul 27, 2024. doi: 10.4240/wjgs.v16.i7.2167
“Hepatic hilum area priority, liver posterior first”: An optimized strategy in laparoscopic resection for type III-IV hilar cholangiocarcinoma
Xiao-Si Hu, Yong Wang, Hong-Tao Pan, Chao Zhu, Shi-Lei Chen, Shuai Zhou, Hui-Chun Liu, Qing Pang, Hao Jin
Xiao-Si Hu, Yong Wang, Hong-Tao Pan, Chao Zhu, Shi-Lei Chen, Shuai Zhou, Hui-Chun Liu, Qing Pang, Hao Jin, Department of Hepatopancreatobiliary Surgery, Anhui No. 2 Provincial People's Hospital, Hefei 230041, Anhui Province, China
Co-corresponding authors: Qing Pang and Hao Jin.
Author contributions: Hu XS and Wang Y contributed to the manuscript preparation; Pan HT and Zhou S helped to perform the statistical analysis and the literature research; Hu XS, Zhu C, and Chen SL contributed to data collection and analysis; Liu HC guided and supervised the research; Jin H conceptualized, designed, and supervised the whole process of the research; Pang Q was responsible for data re-analysis, figures and tables plotting, language polishing, and literature search. Both Jin H and Pang Q played important and indispensable roles in the study design, data analysis and manuscript preparation as the co-corresponding authors. This collaboration between Jin H and Pang Q is crucial for the publication of this manuscript.
Supported by the Health Research Program of Anhui, No. AHWJ2022b032 and No. AHWJ2023A30034.
Institutional review board statement: This study received approval from the Ethics Committee of the Second People’s Hospital of Anhui Province (approval number: 2022-011).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to operation.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hao Jin, MD, PhD, Professor, Department of Hepatopancreatobiliary Surgery, Anhui No. 2 Provincial People's Hospital, No. 1868 Dangshan Road, Hefei 230041, Anhui Province, China. jinhaogandan@126.com
Received: March 27, 2024
Revised: May 31, 2024
Accepted: June 20, 2024
Published online: July 27, 2024
Processing time: 117 Days and 8.5 Hours
Abstract
BACKGROUND

In recent years, pure laparoscopic radical surgery for Bismuth-Corlette type III and IV hilar cholangiocarcinoma (HCCA) has been preliminarily explored and applied, but the surgical strategy and safety are still worthy of further improvement and attention.

AIM

To summarize and share the application experience of the emerging strategy of “hepatic hilum area dissection priority, liver posterior separation first” in pure laparoscopic radical resection for patients with HCCA of Bismuth-Corlette types III and IV.

METHODS

The clinical data and surgical videos of 6 patients with HCCA of Bismuth-Corlette types III and IV who underwent pure laparoscopic radical resection in our department from December 2021 to December 2023 were retrospectively analyzed.

RESULTS

Among the 6 patients, 4 were males and 2 were females. The average age was 62.2 ± 11.0 years, and the median body mass index was 20.7 (19.2-24.1) kg/m2. The preoperative median total bilirubin was 57.7 (16.0-155.7) μmol/L. One patient had Bismuth-Corlette type IIIa, 4 patients had Bismuth-Corlette type IIIb, and 1 patient had Bismuth-Corlette type IV. All patients successfully underwent pure laparoscopic radical resection following the strategy of “hepatic hilum area dissection priority, liver posterior separation first”. The operation time was 358.3 ± 85.0 minutes, and the intraoperative blood loss volume was 195.0 ± 108.4 mL. None of the patients received blood transfusions during the perioperative period. The median length of stay was 8.3 (7.0-10.0) days. Mild bile leakage occurred in 2 patients, and all patients were discharged without serious surgery-related complications.

CONCLUSION

The emerging strategy of “hepatic hilum area dissection priority, liver posterior separation first” is safe and feasible in pure laparoscopic radical surgery for patients with HCCA of Bismuth-Corlette types III and IV. This strategy is helpful for promoting the modularization and process of pure laparoscopic radical surgery for complicated HCCA, shortens the learning curve, and is worthy of further clinical application.

Keywords: Hilar cholangiocarcinoma; Bismuth-Corlette types III and IV; Laparoscopy; Radical resection; Strategy

Core Tip: In recent years, pure laparoscopic radical surgery for Bismuth-Corlette types III and IV hilar cholangiocarcinoma (HCCA) has been preliminarily explored and applied, while the surgical strategy and safety remain worthy of further improvement. We summarized the application experience of the strategy of “hepatic hilum area dissection priority, liver posterior separation first” in pure laparoscopic radical resection for patients with HCCA of Bismuth-Corlette types III and IV. All the 6 patients successfully received pure laparoscopic radical resection with this strategy. None of the patients had blood transfusion during perioperative period. All patients were discharged without serious surgery-related complications. The strategy of “hepatic hilum area dissection priority, liver posterior separation first” is safe and feasible in the pure laparoscopic radical surgery for Bismuth-Corlette types III and IV HCCA.