Right-sided ligamentum teres(RSLT) is a congenital anomaly in which the right umbilical ligament becomes dominant and anomalous ramifications of the hepatic vessels and biliary system are present. A male patient in hi...Right-sided ligamentum teres(RSLT) is a congenital anomaly in which the right umbilical ligament becomes dominant and anomalous ramifications of the hepatic vessels and biliary system are present. A male patient in his 70 s was diagnosed with advanced gallbladder cancer directly infiltrating the right hepatic duct(RHD), together with RSLT. Preoperative three-dimensional simulation of the liver based on multiple detector computed tomography images after cholangiography revealed ramifications of all segmental portal veins from the portal trunk and discordance of the arterial and biliary branching patterns of segment 8. Fusion analysis of the biliary architecture and segmental volumetry showed that the RHD drained segments 1 r, 5, 6, and 7. We successfully performed a modified right-sided hepatectomy sparing segment 8(i.e., resection of the RHD drainage territory), with negative surgical margins. This report is the first to describe major hepatectomy for advanced gallbladder cancer with RSLT.展开更多
Surgical margin is an important prognosticator in patients undergoing hepatectomy for colorectal liver metastases(CRLM)(1).However,the incidence of cut-end recurrence is relatively low,approximately 5-20%,even in pati...Surgical margin is an important prognosticator in patients undergoing hepatectomy for colorectal liver metastases(CRLM)(1).However,the incidence of cut-end recurrence is relatively low,approximately 5-20%,even in patients with pathologically positive(R1)resection(1).Therefore,cut-end recurrence is not an underlying cause of poor prognosis in patients with narrow surgical margin,but it is thought to reflect tumor progression and biology(1,2).展开更多
文摘Right-sided ligamentum teres(RSLT) is a congenital anomaly in which the right umbilical ligament becomes dominant and anomalous ramifications of the hepatic vessels and biliary system are present. A male patient in his 70 s was diagnosed with advanced gallbladder cancer directly infiltrating the right hepatic duct(RHD), together with RSLT. Preoperative three-dimensional simulation of the liver based on multiple detector computed tomography images after cholangiography revealed ramifications of all segmental portal veins from the portal trunk and discordance of the arterial and biliary branching patterns of segment 8. Fusion analysis of the biliary architecture and segmental volumetry showed that the RHD drained segments 1 r, 5, 6, and 7. We successfully performed a modified right-sided hepatectomy sparing segment 8(i.e., resection of the RHD drainage territory), with negative surgical margins. This report is the first to describe major hepatectomy for advanced gallbladder cancer with RSLT.
文摘Surgical margin is an important prognosticator in patients undergoing hepatectomy for colorectal liver metastases(CRLM)(1).However,the incidence of cut-end recurrence is relatively low,approximately 5-20%,even in patients with pathologically positive(R1)resection(1).Therefore,cut-end recurrence is not an underlying cause of poor prognosis in patients with narrow surgical margin,but it is thought to reflect tumor progression and biology(1,2).
