Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 6, 2020; 8(1): 68-75
Published online Jan 6, 2020. doi: 10.12998/wjcc.v8.i1.68
Application of multiple Roux-en-Y hepaticojejunostomy reconstruction by formation of bile hilar duct lake in the operation of hilar cholangiocarcinoma
Xiao-Jun Yang, Xiao-Hua Dong, Shi-Yong Chen, Biao Wu, Yu He, Bao-Long Dong, Bing-Qiang Ma, Peng Gao
Xiao-Jun Yang, Xiao-Hua Dong, Bing-Qiang Ma, Peng Gao, Department of General Surgery, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
Shi-Yong Chen, Biao Wu, School of Clinical Medicine, Ningxia Medical University, Yinchuan 750000, Ningxia Hui Autonomous Region, China
Yu He, Bao-Long Dong, School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou 730000, Gansu Province, China
Author contributions: Yang XJ, Dong XH, and Chen SY contributed equally to this work; Yang XJ, Dong XH, Chen SY, and Gao P contributed to the conception and design; Wu B, He Y, and Dong BL acquired the data; Yang XJ, Dong XH, and Chen SY analyzed and interpreted the data; Dong XH, Chen SY, and Ma BQ drafted the article; Gao P critically reviewed the article and approved the final article; All authors reviewed and approved this article to be published.
Supported by National Natural Science Foundation of China, No. 81260326 and No. 81660398; and Natural Science Foundation of Gansu Province, No. 17JR5RA034.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Gansu Provincial hospital (2019-145).
Informed consent statement: All surgeries were per-formed after the patient or their relatives signed the informed consent form.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Data sharing statement: No additional data are available.
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 Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Peng Gao, MD, Chief Physician, Doctor, Professor, Surgeon, Department of General Surgery, Gansu Provincial Hospital, No. 204 Donggang West Road, Lanzhou 730000, Gansu Province, China. yangxjmd@aliyun.com
Received: August 8, 2019
Peer-review started: August 8, 2019
First decision: October 14, 2019
Revised: November 10, 2019
Accepted: November 14, 2019
Article in press: November 14, 2019
Published online: January 6, 2020
Processing time: 151 Days and 20.5 Hours
Abstract
BACKGROUND

Hilar cholangiocarcinoma is the most common malignant tumor of the extrahepatic bile duct. Until now, radical resection has been the most effective method for the long-term survival of patients with the disease. However, many problems have emerged in the field of hepatobiliary surgery for a long time, including complex surgical procedures, low resection rate, and postoperative complications. We have adopted the “multiple Roux-en-Y hepaticojejunostomy reconstruction by formation of a bile duct lake“ technique in the treatment of hilar cholangiocarcinoma since 2008, and obtained satisfactory short- and long-term results.

AIM

To examine the feasibility of the application of multiple Roux-en-Y hepaticojejunostomy reconstruction by formation of a bile duct lake in the operation of hilar cholangiocarcinoma.

METHODS

A retrospective analysis was performed for the clinical data, surgical methods, and results of 76 patients with hilar cholangiocarcinoma who were treated with hilar bile duct lake-forming multiple Roux-en-Y hepaticojejunostomy reconstruction at Gansu Provincial Hospital.

RESULTS

In all 76 cases, the operation was successful and no operative death occurred. The mean (range) operation time was 215.4 ± 53.5 min (124–678 min), and the amount of bleeding during the operation was 428.2 ± 63.8 mL (240–2200 mL). The overall 1-year survival rate was 78.9%, and the 3-year survival rate was 32.8%.

CONCLUSION

The multiple Roux-en-Y hepaticojejunostomy reconstruction technique with formation of a bile duct lake is safe and effective for the surgical treatment of hilar cholangiocarcinoma.

Keywords: Hilar cholangiocarcinoma; Bile duct lake; Hepaticojejunostomy

Core tip: Hilar cholangiocarcinoma accounts for approximately 50% of all cholangiocarcinomas. Until now, radical resection has been the most effective method for the long-term survival of patients with the disease. However, many problems have emerged in the field of hepatobiliary surgery over time, including complex surgical procedures, low resection rates, and postoperative complications. We have adopted the "multiple Roux-en-Y hepaticojejunostomy reconstruction by formation of a bile duct lake" technique in the treatment of hilar cholangiocarcinoma since 2008, and obtained satisfactory short- and long-term results.