Background
Complex, highly variable, anatomic relationships in the portal hilum complicate the
surgical management at hilar cholangiocarcinoma. Preoperative three-dimensional (3D)
imaging to stage the tumor and define anatomy may help in planning for curative resection.
Methods
Between 2003 and 2006, 20 consecutive patients with hilar cholangiocarcinoma underwent
preoperative multidetector row computed tomography (MDCT) cholangiography; 3D images
of the portal vein, hepatic artery, and bile ducts were created and viewed simultaneously.
Longitudinal tumor extension was evaluated by direct cholangiography and 3D cholangiography,
and contiguous spread by 2D computed tomography (CT). Of 20 patients, 15 underwent
surgical resection. Liver resection was planned based on 3D imaging that allowed visualization
of the relationship between the tumor and the umbilical portion of the left portal
vein, or the bifurcation of the anterior and posterior branch of the right portal
vein. Preoperative and operative findings were compared.
Results
All patients tolerated 3D CT without serious complication. The accuracy rates of longitudinal
tumor extension, using the Bismuth-Corlette classification system, were 85% (11/13)
and 87% (13/15) with direct cholangiography and 3D cholangiography, respectively.
The sensitivity, specificity, and accuracy rates were 100%, 80%, and 87% for portal
invasion and 75%, 91%, and 87% for hepatic arterial invasion. The number of bile duct
orifices in the cut end of the hilar plate was estimated correctly in 13 of 15 patients.
There were no operative deaths. Potentially curative resection was achieved in 14
of 15 patients.
Conclusions
3D images provide accurate information about the relationship between hilar cholangiocarcinoma
and adjacent vessels. This technique is a powerful new tool for improving the proportion
of potentially curative resection.
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Article info
Publication history
Accepted:
May 5,
2007
Identification
Copyright
© 2007 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
