Liver Resections Associated with Proximal Bile Duct Cancer

Proximal bile duct resections often mandate resection of liver substance as well and this chapter outlines the various procedures which are performed for excision of proximal bile duct cancers associated with a liver resection. Because of the proximity of segment one to the biliary confluence, it is this segment which has to be resected with a proximal bile duct cancer. If there has been tumour spread to blood vessels or the hepatic duct associated with the right or left the liver, then a right or left hepatectomy is often required in association with the resection of the malignancy, and these procedures are also described, as well as with extension to other segments of the liver. Occasionally it appears that removal of medial sectors of both livers(segments 4, 5 and 8) is necessary when a tumour is very central and so then a so-called central hepatectomy can be carried out and is described here. This is removal of segment one, four, five and eight. Hepatic resection with excision of the portal vein and sometimes even hepatic arteries can be undertaken and is described. Even more extreme techniques, such as total liver excision with transplantation or cluster operations are also described.