Does the anatomical assumption used to choose a side for perihilar bile duct cancer surgery hold up when ducts are measured?

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Right-sided hepatectomy is often selected for perihilar cholangiocarcinoma because of the anatomical assumption that the left hepatic duct is longer than the right hepatic duct. However, only one study had briefly mentioned hepatic duct length. The researchers aimed to test whether this assumption was correct.

The research included a surgical measurement study and a radiological measurement study. In the surgical study, researchers measured the lengths of resected bile ducts using photographs of resected specimens from 475 patients who underwent hepatectomy for perihilar cholangiocarcinoma. In the radiological study, they measured the estimated lengths of bile ducts to be resected using cholangiograms reconstructed from computed tomography images in 61 patients with distal bile duct obstruction.

In the surgical study, the resected left hepatic duct measured 25.1 ± 6.4 mm in right trisectionectomy (n = 37) and 14.9 ± 5.7 mm in right hepatectomy (n = 167). The right hepatic duct measured 14.1 ± 5.7 mm in left hepatectomy (n = 149) and 21.3 ± 6.4 mm in left trisectionectomy (n = 122).

In the radiological study, the corresponding estimated duct lengths were 34.1 ± 7.8 mm for right trisectionectomy, 22.4 ± 7.1 mm for right hepatectomy, 20.8 ± 4.8 mm for left hepatectomy, and 31.6 ± 5.3 mm for left trisectionectomy.

Both studies found that the lengths of the bile ducts resected, or estimated to be resected, were similar between right and left hepatectomies, significantly shorter in right hepatectomy than in left trisectionectomy, and longest in right trisectionectomy.

The authors concluded that the anatomical assumption was a surgeon's biased view. Based on their observations, they recommended flexible selection of the surgical procedure.