Hepatic Artery Reconstruction For Advanced Hilar Cholangiocarcinoma: Surgical Indication Expanded

Objective: To outline our experience with reconstruction of the hepatic artery during radical resection of hilar cholangiocarcinoma, and to discuss the clinical significance of this challenging surgery. Methods: We retrospectively reviewed clinical data of 16 patients with advanced hilar cholangiocarcinoma who underwent left hepatectomy with simultaneous resection and reconstruction of the right hepatic artery with or without portal vein reconstruction, focusing on the type of hepatic artery reconstruction and surgical outcome. Results: Right hepatic artery was reconstructed with end-to-end anastomosis (n=10), using the autologous greater saphenous vein graft interposition (n=1), the autologous left hepatic artery graft interposition (n=2), the reserved left hepatic artery (n=1), or the gastroduodenal artery (n=2), among which 6 patients underwent portal vein reconstruction simultaneously. Post-operative pathology showed poorly differentiated adenocarcinoma in 6 patients, moderately differentiated adenocarcinoma in 8 and well differentiated adenocarcinoma in 2. R0 resection was achieved in 15 patients. There was no postoperative liver failure, biliary-enteric anastomotic leakage or perioperative deaths. Conclusions: Reconstruction of the hepatic artery can improve the radical resection rate of advanced hilar cholangiocarcinoma and control the postoperative complications, which is safe and feasible in selected patients.