Safety of combined resection of the middle hepatic artery in right hemihepatectomy for hilar biliary malignancy

In patients with hilar biliary malignancies, preservation of the middle hepatic artery (MHA, segment IV artery) where it runs close to the tumor in the hepatic hilum may lead to resection with positive margins. This retrospective study assessed the safety of combined resection of the MHA with right hemihepatectomy, caudate lobectomy, and bile duct resection for hilar biliary malignancies. Of 61 patients with hilar biliary malignancies who underwent right hemihepatectomy, we classified the branching patterns of the MHA according to the origins and courses in the hilum. The MHA was resected without reconstruction in 16 patients in whom the artery ran close to the tumor. We compared the perioperative outcomes in these patients with those of patients who did not undergo resection of the artery. Anatomically, the MHA ran on the right side of the umbilical portion of the portal vein in 40 (66%) patients. Perioperative data for the patients who underwent combined resection were similar to those in whom the MAH was preserved. There were no postoperative complications that could be directly related to the arterial resection. Combined resection of the MHA during right hemihepatectomy for hilar biliary malignancies has a safe perioperative course.