Unilateral hepatic artery reconstruction is unnecessary in biliary tract carcinomas involving lobar hepatic artery: Implications of interlobar hepatic artery and its preservation

Background/Aims: The interruption of hepatic arterial flow when performing a bilioenteric anastomosis has been reported to usually bring about serious postoperative complications, such as anastomotic leakage, hepatic abscess and infarction. We aimed to evaluate the surgical implications of the inter lobar hepatic artery when patients with advanced biliary tract carcinomas u ndergo surgical resection with a bilioenteric anastomosis. Methodology: In 7 patients with advanced biliary tract carcinomas, the comb ined resection of the liver (greater than hemihepatectomy in 2 and less tha n hemihepatectomy in 5), extrahepatic bile duct, hepatic artery (right hepa tic artery in 5, right and left hepatic artery in 1, left hepatic artery in 1), and the portal vein was performed in 4 patients. The portal vein was r econstructed in all 4 patients. The hepatic artery was reconstructed in onl y one patient, with combined resection of both right and left hepatic arter ies, but was not reconstructed in 2 other patients, even though they underw ent resection greater than hemihepatectomy. Results: The interlobar hepatic artery running into the Glissonian sheath a round the hepatic duct confluence could be preserved in 5 patients, as show n by angiography, but could not be preserved in 2 patients who underwent gr eater than hemihepatectomy. Moderate and transient ischemic liver damage oc curred, but no serious postoperative complications were induced in any of t he 5 patients in the unilateral hepatic artery preserved group. However, bo th cases without preservation of the hepatic artery encountered liver failu re, liver abscess and leakage of bilioenteric anastomosis, and one patient died of multiple organ failure. Conclusions: One major lobar branch of the hepatic artery involved by cance r invasion could be safely resected without reconstruction in patients with advanced biliary tract carcinomas when the interlobar hepatic artery runni ng into the Glissonian sheath around the hepatic duct confluence is preserv ed.