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Hepatobiliary Surgery Blumgart

Text of Hepatobiliary Surgery Blumgart

LANDESBIOSCIENCE

V ad e me c u mHepatobiliary Surgery

Ronald S. Chamberlain Leslie H. Blumgart

v a d e m e c u m

Hepatobiliary Surgery

Ronald S. Chamberlain, MD, MPA, FACSBeth Israel Medical Center Albert Einstein College of Medicine New York, New York

Leslie H. Blumgart, MD, FACS, FRCS (Eng, Edin), FRCPS (Glas)Memorial-Sloan-Kettering Cancer Center New York, New York

LANDESBIOSCIENCE

GEORGETOWN, TEXAS U.S.A.

VADEMECUM Hepatobiliary Surgery LANDES BIOSCIENCE Georgetown, Texas U.S.A. Copyright 2003 Landes Bioscience All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the publisher. Printed in the U.S.A. Please address all inquiries to the Publisher: Landes Bioscience, 810 S. Church Street, Georgetown, Texas, U.S.A. 78626 Phone: 512/ 863 7762; FAX: 512/ 863 0081 ISBN: 1-57059-630-1

Library of Congress Cataloging-in-Publication Data Hepatobiliary surgery / [edited by] Ronald S. Chamberlain, Leslie H. Blumgart. p.; cm. -- (Vademecum) Includes bibliographical references and index. Ronald S. Chamberlain ISBN 1-57059-630-1 1. Liver -- Surgery -- Handbooks, manuals, etc. 2. Biliary tract -Surgery -- Handbooks, manuals, etc. I. Chamberlain, Ronald S. II. Blumgart, L. H. III. Series. [DNLM: 1. Liver Diseases -- surgery. 2. Biliary Tract Diseases -surgery. 3. Digestive System Surgical Procedures. WI 770 H52995 2001] RD546.H358 2001 617.556059 -- dc21 00-064876

While the authors, editors, sponsor and publisher believe that drug selection and dosage and the specifications and usage of equipment and devices, as set forth in this book, are in accord with current recommendations and practice at the time of publication, they make no warranty, expressed or implied, with respect to material described in this book. In view of the ongoing research, equipment development, changes in governmental regulations and the rapid accumulation of information relating to the biomedical sciences, the reader is urged to carefully review and evaluate the information provided herein.

DedicationThe surgical care of patients is a full commitment. As most of you will realize, accepting any additional commitments beyond clinical medicine is a burden that is borne by the family of the practicing surgeon. This past year has been a tremendous burden on my family as several works came to fruition. To Kim, the light and joy in my life thank you, I love you. To Courtney and Taylor, Daddy is so proud of both you. You are all the sources of my inspiration and contentment. Ronald S. Chamberlain

ContentsPreface ............................................................................ xiii 1. Essential Hepatic and Biliary Anatomy for the Surgeon ................................................................. 1Ronald S. Chamberlain and Leslie H. Blumgart Introduction ............................................................................................... 1 The Liver .................................................................................................... 1 Parenchyma (The Liver Substance) ............................................................. 2 Hepatic Veins (OUTFLOW) ...................................................................... 4 Hepatic Venous Anomalies ......................................................................... 6 Hepatic Arteries (INFLOW) ....................................................................... 6 The Biliary Tract ....................................................................................... 10 The Common Bile Duct ........................................................................... 11 Gallbladder and Cystic Duct ..................................................................... 12 Anomalous Biliary Drainage ..................................................................... 16 Summary .................................................................................................. 17

2. Imaging of the Liver, Bile Ducts and Pancreas ................ 20Douglas R. DeCorato, Lawrence H. Schwartz Test Selection ............................................................................................ 21 Hepatic Lesions ........................................................................................ 23

3. Endoscopic and Percutaneous Management of Gallstones ................................................................... 34Seth Richter and Robert C. Kurtz Introduction ............................................................................................. 34 Endoscopic Retrograde Sphincterotomy ................................................... 34 Bile Duct Stone Retrieval .......................................................................... 35 Complications of Endoscopic Therapy ...................................................... 38 Percutaneous Stone Extraction .................................................................. 38 Specific Clinical Problems ......................................................................... 39 The Era of Laparoscopic Cholecystectomy ................................................ 40

4. Interventional Radiology in Hepatobiliary Surgery ........ 42Lynn A. Brody and Karen T. Brown Introduction ............................................................................................. 42 Diagnostic Procedures ............................................................................... 42 Therapeutic and Palliative Procedures ....................................................... 49

5. Perioperative Care and Anesthesia Techniques ................ 73Mary Fischer, Enrico Ferri, Jose A. Melendez Introduction ............................................................................................. 73 Preoperative Evaluation ............................................................................. 73 Hepatic Evaluation ................................................................................... 74 Intraoperative Management ...................................................................... 74 Postoperative Care .................................................................................... 76

6. Benign Tumors of the Liver: A Surgical Perspective ........ 81Ronald S. Chamberlain Introduction ............................................................................................. 81 Evaluation ................................................................................................. 81 Benign Liver Tumors ................................................................................. 85 Additional Liver Tumors ........................................................................... 97 Conclusions .............................................................................................. 99

7. Hepatocellular Carcinoma ............................................ 101Bryan Clary Introduction ........................................................................................... 101 Etiology .................................................................................................. 101 Diagnosis and Pretreatment Planning ..................................................... 102 Treatment ............................................................................................... 104 Conclusion ............................................................................................. 110

8. Periampullary Cancer and Distal Pancreatic Cancer ........................................ 111Richard D. Schulick Introduction ........................................................................................... 111 Pancreaticoduodenectomy for Periampullary Cancer .............................. 112 Distal Pancreatectomy for Distal Pancreatic Cancer ................................ 115

9. Hepatic Resection for Colorectal Liver Metastases: Surgical Indications and Outcomes .............................. 121Ronald P. DeMatteo, Yuman Fong Introduction ........................................................................................... 121 Epidemiology .......................................................................................... 121 Preoperative Evaluation ........................................................................... 121 Physical Examination .............................................................................. 122 Laboratory Tests ...................................................................................... 122 Imaging .................................................................................................. 122 Surgical Indications ................................................................................. 123 Surgical Results ....................................................................................... 124 Survival ................................................................................................... 125 Prognostic Variables ................................................................................ 126 Recurrent Hepatic Metastases ................................................................. 127 Conclusion ............................................................................................. 127

10. The Surgical Approach to Non-Colorectal Liver Metastases: Patient Evaluation, Selection and Results .................................................... 129Jonathan B. Koea Introduction ........................................................................................... 129 Patient Selection ..................................................................................... 129 Preoperative Sta