Common hepatic duct

Abstract: Background: Although intraoperative cholangiography has been recommended for avoiding bile duct injury during laparoscopic cholecystectomy, radiographic cholangiography is time consuming and may itself cause injury to the bile duct. Recently, a novel fluorescent cholangiography technique using the intravenous injection of indocyanine green (ICG) has been developed. Methods: In 52 patients undergoing laparoscopic cholecystectomy, 2·5 mg ICG was injected intravenously 30 min before the patient entered the operating room or following intubation. A fluorescent imaging system, which consisted of a xenon light source and a laparoscope with a charge-coupled device camera that could filter out light wavelengths below 810 nm, was used. Fluorescent cholangiography was performed during dissection of Calot's triangle, and its ability to delineate biliary anatomy was compared with that of preoperative cholangiography. Results: Fluorescent cholangiography delineated the cystic duct in all 52 patients, and the cystic duct–common hepatic duct junction was visible before dissection of Calot's triangle in 50 patients. Fluorescent imaging also identified all accessory bile ducts that had been diagnosed before surgery in eight patients. Conclusion: Fluorescent cholangiography enables real-time identification of biliary anatomy during dissection of Calot's triangle. This simple technique may become standard practice for avoiding bile duct injury during laparoscopic cholecystectomy, replacing radiographic cholangiography. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Abstract: Although reported 5-year survival rates of extrahepatic bile duct cancer lie between 20% and 30%, these data do not reflect the actual cure rate. Some patients survive longer than 5 years with recurrent disease. In some patients, recurrence is detected after 5 years. Accordingly, true cure rate is probably substantially lower than the 5-year survival rate reported in curatively resected cases. Sometimes patients survive a few years after a drainage procedure only, and others who undergo resection with microscopic tumor involvement of the bile duct margin survive longer than expected. Such rather unusual outcomes probably stem from the slow-growing characteristics of the tumor. Moreover, the majority of studies that have reported prognostic factors and survival outcome1–7 have been limited because few studies have been large enough in scope, with respect to patient number and/or long term follow up to properly determine the actual long-term clinical course. Extrahepatic bile duct cancer is usually classified as upper, middle, or distal bile duct cancer according to the anatomic location8; however, tumors are rarely confined to 1 segment because bile duct cancer tends to spread along the bile duct wall longitudinally. Pancreatoduodenectomy is generally performed in cases of distal and mid third cancer (common bile duct cancer) and bile duct resection, without or with hepatectomy (hepatobiliary resection), for proximal third cancer (common hepatic duct and Klatskin tumor). Moreover, it seems reasonable that survival analysis based on the type of resection would be more practical and helpful to surgeons rather than the poorer definable location-based system currently used. The purpose of this study was to determine actual survival in patients with extrahepatic bile duct cancer according to resection type, at least to the postoperative 5-year stage, and to identify those factors associated with long-term survival. We also investigated the status of patients at the 5-year stage to include late recurrence and recurrence pattern in our analysis of long-term outcome.