Table Of ContentPrometheus, chained to the rocky Mount Caucasus, has his liver eaten by the eagle of Zeus. (Engraving, 1566, possibly after a work by Titian.
Reproduced by permission of the Hulton Getty Picture Collection, London.)
BLUMGART’S
Surgery Liver,
of the
Biliary Tract, Pancreas
and
6th EDITION
EDITOR-IN-CHIEF
William R. Jarnagin, MD, FACS
ASSOCIATE EDITORS
Peter J. Allen, MD
William C. Chapman, MD, FACS
Michael I. D’Angelica, MD, FACS
Ronald P. DeMatteo, MD, FACS
Richard Kinh Gian Do, MD, PhD
Jean-Nicolas Vauthey, MD, FACS
EDITOR EMERITUS
Leslie H. Blumgart, BDS, MD, DSc(Hon), FACS, FRCS(Eng, Edin), FRCPS(Glas)
VOLUME 1
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
Blumgart’s Surgery of the Liver, Biliary Tract, and Pancreas ISBN: 978-0-323-34062-5
Copyright © 2017 by Elsevier, Inc. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means,
electronic or mechanical, including photocopying, recording, or any information storage and retrieval
system, without permission in writing from the publisher. Details on how to seek permission, further
information about the Publisher’s permissions policies and our arrangements with organizations such
as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website:
www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the
Publisher (other than as may be noted herein).
Notices
Knowledge and best practice in this field are constantly changing. As new research and experience
broaden our understanding, changes in research methods, professional practices, or medical
treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in
evaluating and using any information, methods, compounds, or experiments described herein. In
using such information or methods they should be mindful of their own safety and the safety of
others, including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check
the most current information provided (i) on procedures featured or (ii) by the manufacturer of
each product to be administered, to verify the recommended dose or formula, the method and
duration of administration, and contraindications. It is the responsibility of practitioners, relying
on their own experience and knowledge of their patients, to make diagnoses, to determine dosages
and the best treatment for each individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors,
assume any liability for any injury and/or damage to persons or property as a matter of products
liability, negligence or otherwise, or from any use or operation of any methods, products,
instructions, or ideas contained in the material herein.
Previous editions copyrighted 2012, 2007, 2000, 1994, and 1988 by Saunders, an imprint of
Elsevier Inc.
Library of Congress Cataloging-in-Publication Data
Names: Jarnagin, William R. (Surgeon), editor.
Title: Blumgart’s surgery of the liver, biliary tract, and pancreas / editor-in-chief, William R. Jarnagin ;
associate editors, Peter J.Allen, William C. Chapman, Michael I. D’Angelica, Ronald P. DeMatteo,
Richard Kinh Gian Do, Jean-Nicolas Vauthey ; editor emeritus, Leslie H. Blumgart.
Other titles: Surgery of the liver, biliary tract, and pancreas
Description: Sixth edition. | Philadelphia, PA : Elsevier, [2017] | Includes bibliographical references
and index.
Identifiers: LCCN 2016013975 | ISBN 9780323340625 (hardcover)
Subjects: | MESH: Liver–surgery | Biliary Tract Surgical Procedures | Pancreas–surgery
Classification: LCC RD669 | NLM WI 770 | DDC 617.5/56–dc23 LC record available at http://
lccn.loc.gov/2016013975
Executive Content Strategist: Michael Houston
Senior Content Development Specialist: Dee Simpson
Publishing Services Manager: Patricia Tannian
Project Manager: Stephanie Turza
Design Direction: Maggie Reid
Printed in China
Last digit is the print number: 9 8 7 6 5 4 3 2 1
This book is dedicated to
the development of surgery of the liver, biliary tract,
and pancreas as a specialty.
EDITORS
EDITOR-IN-CHIEF Ronald P. DeMatteo, MD, FACS
Vice Chair, Department of Surgery
William R. Jarnagin, MD, FACS Chief, Division of General Surgical Oncology
Chief, Hepatopancreatobiliary Surgery Leslie H. Blumgart Chair in Surgery
Benno C. Schmidt Professor of Surgical Oncology Memorial Sloan Kettering Cancer Center
Memorial Sloan Kettering Cancer Center; New York, New York
Professor of Surgery
Weill Medical College of Cornell University Richard Kinh Gian Do, MD, PhD
New York, New York Associate Professor of Radiology
Weill Medical College of Cornell University;
ASSOCIATE EDITORS Assistant Attending Physician
Department of Radiology
Peter J. Allen, MD Memorial Sloan Kettering Cancer Center
Professor of Surgery New York, New York
Department of Surgery
Memorial Sloan Kettering Cancer Center Jean-Nicolas Vauthey, MD, FACS
New York, New York Professor of Surgical Oncology
Chief, Hepato-Pancreato-Biliary Section
William C. Chapman, MD, FACS Bessie McGoldrick Professor in Clinical Cancer Research
Professor Department of Surgical Oncology
Chief, Division of General Surgery University of Texas MD Anderson Cancer Center
Chief, Abdominal Transplantation Section Houston, Texas
Washington University School of Medicine
St. Louis, Missouri EDITOR EMERITUS
Michael I. D’Angelica, MD, FACS Leslie H. Blumgart, BDS, MD, DSc(Hon), FACS,
Attending Surgeon FRCS(Eng, Edin), FRCPS(Glas)
Hepatopancreatobiliary Surgery Member
Enid A. Haupt Chair in Surgery Professor of Surgery and Attending Surgeon
Memorial Sloan Kettering Cancer Center; Memorial Sloan Kettering Cancer Center;
Associate Professor Professor of Surgery
Department of Surgery Weill Medical College of Cornell University
Weill Medical College of Cornell University New York, New York
New York, New York
vii
CONTRIBUTORS
Ghassan K. Abou-Alfa, MD Jesper B. Andersen, MD
Assistant Attending Physician Biotech Research and Innovation Centre (BRIC)
Memorial Sloan Kettering Cancer Center; Department of Health and Medical Sciences
Assistant Professor University of Copenhagen
Weill Medical College of Cornell University Copenhagen, Denmark
New York, New York
Christopher D. Anderson, MD
Jad Abou Khalil, MD, CM James D. Hardy Professor and Chair
Chief Resident Department of Surgery
McGill University Health Centre University of Mississippi Medical Center
Montreal, Quebec, Canada Jackson, Mississippi
Pietro Addeo, MD Vittoria Arslan-Carlon, MD
Attending Surgeon Assistant Anesthesiologist
Hepato-Pancreato-Biliary Surgery and Liver Transplantation Department of Anesthesiology and Critical Care
University of Strasbourg Memorial Sloan Kettering Cancer Center
Strasbourg, France New York, New York
N. Volkan Adsay, MD Horacio J. Asbun, MD, FACS
Professor and Vice-Chair Professor of Surgery
Director of Anatomic Pathology Department of Surgery
Emory University Mayo Clinic
Atlanta, Georgia Jacksonville, Florida
Anil Kumar Agarwal, MCh, FRCS, FACS Béatrice Aussilhou, MD
Professor Department of Hepato-Pancreatic-Biliary Surgery and Liver
Director Transplantation
Department of GI Surgery and Liver Transplant Beaujon Hospital
Govind Ballabh Pant institute of Postgraduate Medical Clichy, France
Education & Research
Maulana Azad Medical College Joseph Awad, MD
New Delhi, India Professor of Medicine
Department of Gastroenterology and Hepatology
Farzad Alemi, MD Vanderbilt University;
Assistant Professor and Section Chief Chief
Department of Hepatopancreatobiliary Surgery Transplant Center
University of Missouri–Kansas City Tennessee Valley Healthcare System
Kansas City, Missouri Nashville, Tennessee
Peter J. Allen, MD Daniel Azoulay, MD, PhD
Professor of Surgery Professor of Surgery
Department of Surgery Department of Digestive, HPB and Liver Transplant Surgery
Memorial Sloan Kettering Cancer Center Hôpital Henri Mondo
New York, New York Assistance Publique-Hôpitaux de Paris Faculté de Médecine
Université Paris-Est-Créteil
Ahmed Al-Mukhtar, MD Créteil, France
Consultant
Hepatobiliary Surgeon Philippe Bachellier, MD, PhD
Sheffield Teaching Hospitals Professor and Chairman
Sheffield, England Hepato-Pancreato-Biliary Surgery and Liver Transplantation
Pôle des Pathologies Digestives
Thomas A. Aloia, MD Hépatiques et de la Transplantation
Associate Professor of Surgical Oncology Hôpital de Hautepierre-Hôpitaux
Department of Surgical Oncology Universitaires de Strasbourg
University of Texas MD Anderson Cancer Center Strasbourg, France
Houston, Texas
viii
CONTRIBUTORS ix
Talia B. Baker, MD Marc G. H. Besselink, MD, PhD
Associate Professor of Surgery Hepato-Pancreato-Biliary Surgeon
Division of Transplantation Academic Medical Center
Department of Surgery Amsterdam, The Netherlands
Northwestern University Feinberg School of Medicine
Chicago, Illinois Anton J. Bilchik, MD, PhD
Professor of Surgery
Zubin M. Bamboat, MD Chief of Medicine
Department of Surgery Chief of Gastrointestinal Research Program
Memorial Sloan Kettering Cancer Center John Wayne Cancer Institute
New York, New York Providence Saint John’s Health Center
Santa Monica, California
Jeffrey Stewart Barkun, MD, FRSC(C)
Professor of Surgery Leslie H. Blumgart, BDS, MD, DSc(Hon), FACS,
Department of Hepatobiliary & Transplant Surgery FRCS(Eng, Edin), FRCPS(Glas)
McGill University Health Centre Member
Montreal, Quebec, Canada Professor of Surgery and Attending Surgeon
Memorial Sloan Kettering Cancer Center;
Claudio Bassi, FRCS, FACS, FEBS Professor of Surgery
Professor of Surgery Weill Medical College of Cornell University
Pancreas Institute New York, New York
Verona University Hospital Trust
Verona, Italy Franz Edward Boas, MD, PhD
Assistant Attending Physician
Olca Basturk, MD Department of Radiology
Assistant Attending Physician Memorial Sloan Kettering Cancer Center
Department of Pathology New York, New York
Memorial Sloan Kettering Cancer Center;
Assistant Professor Lynn A. Brody, MD
Department of Pathology and Laboratory Medicine Attending Interventional Radiologist
Weill Medical College of Cornell University Department of Diagnostic Radiology
New York, New York Memorial Sloan Kettering Cancer Center
New York, New York
Rachel E. Beard, MD
Resident Physician Karen T. Brown, MD, FSIR
Department of Surgery Attending Radiologist
Beth Israel Deaconess Medical Center Department of Radiology
Boston, Massachusetts Memorial Sloan Kettering Cancer Center;
Professor of Clinical Radiology
Pierre Bedossa, MD, PhD Department of Radiology
Professor Weill Medical College of Cornell University
Department of Pathology New York, New York
Beaujon Hospital
Paris, France Jordi Bruix, MD, PhD
Senior Consultant
Jacques Belghiti, MD Liver Unit, BCLC Group
Professor Hospital Clinic
Physician University of Barcelona
Department of Hepato-Pancreatic-Biliary Surgery and Liver Centro de Investigación Biomédica en Red de Enfermedades
Transplantation Hepáticas y Digestivas (CIBERehd)
Beaujon Hospital Barcelona, Spain
Clichy, France
David A. Bruno, MD
Omar Bellorin-Marin, MD Assistant Professor of Surgery
Administrative Chief Resident Transplant Division
Department of Surgery University of Maryland School of Medicine
New York Presbyterian Queens/Weill Medical College of Baltimore, Maryland
Cornell University
Flushing, New York Elizabeth M. Brunt, MD
Professor
Pathology and Immunology
Washington University School of Medicine
St. Louis, Missouri
x CONTRIBUTORS
Justin M. Burns, MD See Ching Chan, MD, PhD
Assistant Professor of Surgery Clinical Professor
Department of Transplantation Department of Surgery
Mayo Clinic The University of Hong Kong
Jacksonville, Florida Hong Kong, China
Giovanni Butturini, MD, PhD William C. Chapman, MD, FACS
Department of Surgery Professor
The Pancreas Institute Chief, Division of General Surgery
Verona University Hospital Trust Chief, Abdominal Transplantation Section
Verona, Italy Washington University School of Medicine
St. Louis, Missouri
Juan Carlos Caicedo, MD
Adult and Pediatric Transplant Surgeon Daniel Cherqui, MD
Associate Professor of Surgery Professor
Department of Surgery Hepatobiliary Surgery and Liver Transplantation
Northwestern Memorial Hospital Paul Brousse Hospital
Northwestern University; Villejuif, France
Pediatric Transplant Surgeon
Department of Surgery Clifford S. Cho, MD
Lurie Children’s Hospital Chief, Division of Surgical Oncology
Chicago, Illinois University of Wisconsin School of Medicine and Public
Health
Mark P. Callery, MD Madison, Wisconsin
Professor of Surgery
Harvard Medical School; Jin Wook Chung, MD, PhD
Chief, Division of General Surgery Professor
Beth Israel Deaconess Medical Center College of Medicine
Boston, Massachusetts Seoul National University
Seoul, Korea
Abdul Saied Calvino, MD
Assistant Professor of Surgery Jesse Clanton, MD
Boston University School of Medicine/Roger Williams Hepatopancreatobiliary Surgery Fellow
Medical Center Section of General, Thoracic and Vascular Surgery
Providence, Rhode Island Virginia Mason Medical Center
Seattle, Washington
Danielle H. Carpenter, MD
Assistant Professor Bryan Marshall Clary, MD
Pathology and Immunology Department of Surgery
Washington University School of Medicine University of California, San Diego
St. Louis, Missouri San Diego, California
C. Ross Carter, MD, FRCS Sean Patrick Cleary, MD, FRCSC
Consultant Pancreatic Surgeon Associate Professor
Glasgow Royal Infirmary Department of Surgery
Glasgow, Scotland University of Toronto
Toronto, Ontario, Canada
François Cauchy, MD
Physician Kelly M. Collins, MD
Hepatobiliary Surgery and Liver Transplantation Unit Senior Staff Surgeon, Transplant and Hepatobiliary Surgery
Beaujon Hospital Henry Ford Hospital
Clichy, France Surgical Director, Liver Transplant
Children’s Hospital of Michigan
Chung Yip Chan, MBBS, MMed(Surgery), Detroit, Michigan
MD, FRCSEd
Senior Consultant John Barry Conneely, MCh, FRCSI
Department of Hepatopancreatobiliary and Transplant Consultant
Surgery Hepatopancreatobiliary Surgeon
Singapore General Hospital Department of Surgery
Singapore Mater Misericordiae Hospital
Dublin, Ireland
CONTRIBUTORS xi
Louise C. Connell, MD Michael D. Darcy, MD
Fellow Professor of Radiology and Surgery
Memorial Sloan Kettering Cancer Center Washington University in St Louis;
New York, New York Chief of Interventional Radiology
Mallinckrodt Institute of Radiology
Carlos U. Corvera, MD, FACS St. Louis, Missouri
Professor of Surgery
Chief, Liver, Biliary and Pancreatic Surgery Jeremy L. Davis, MD
Department of Gastrointestinal Surgical Oncology Assistant Research Physician
Maurice Galante Distinguished Professorship in Center for Cancer Research
Hepatobiliary Surgery National Cancer Institute, NIH
UCSF Helen Diller Family Comprehensive Cancer Center Bethesda, Maryland
San Francisco, California
Jeroen de Jonge, MD, PhD
Guido Costa, MD Assistant Professor
Resident Department of Hepatobiliary and Transplant Surgery
Division of Hepatobiliary and General Surgery Erasmus MC Rotterdam
Humanitas Research Hospital Rotterdam, The Netherlands
Rozzano-Milan, Italy
Ronald P. DeMatteo, MD, FACS
Anne M. Covey, MD Vice Chair, Department of Surgery
Attending Interventional Radiologist Chief, Division of General Surgical Oncology
Department of Diagnostic Radiology Leslie H. Blumgart Chair in Surgery
Memorial Sloan Kettering Cancer Center; Memorial Sloan Kettering Cancer Center
Professor of Radiology New York, New York
Department of Diagnostic Radiology
Weill Medical College of Cornell University Danielle K. DePeralta, MD
New York, New York Surgical Resident
Department of General Surgery
Jeffrey S. Crippin, MD Massachusetts General Hospital
Marilyn Bornefeld Chair in Gastrointestinal Research and Boston, Massachusetts
Treatment
Department of Internal Medicine Niraj M. Desai, MD
Washington University School of Medicine Assistant Professor
St. Louis, Missouri Department of Surgery
Johns Hopkins University School of Medicine
Kristopher P. Croome, MD Baltimore, Maryland
Assistant Professor
Department of Transplant Surgery Eduardo de Santibañes, MD, PhD
Mayo Clinic Chairman
Jacksonville, Florida General Surgery and Liver Transplantation
Professor
Hany Dabbous, MD Department of General Surgery
Professor of Tropical Medicine and Liver Diseases Hospital Italiano
Ain Shams University Buenos Aires, Argentina
Cairo, Egypt
Martin de Santibañes, MD
Michael I. D’Angelica, MD, FACS Associate Professor of Surgery
Attending Surgeon Hepato-Biliary-Pancreatic Unit
Hepatopancreatobiliary Surgery Liver Transplantation Unit
Enid A. Haupt Chair in Surgery Hospital Italiano
Memorial Sloan Kettering Cancer Center; Buenos Aires, Argentina
Associate Professor
Department of Surgery Euan J. Dickson, MD, FRCS
Weill Medical College of Cornell University Consultant Pancreatic Surgeon
New York, New York University of Glasgow
Glasgow, Scotland
xii CONTRIBUTORS
Christopher John DiMaio, MD Imane El Dika, MD
Director of Therapeutic Endoscopy Fellow
Division of Gastroenterology Memorial Sloan Kettering Cancer Center
Icahn School of Medicine at Mount Sinai New York, New York
New York, New York
Yousef El-Gohary, MA, MD, MRCS (Glasg)
Richard Kinh Gian Do, MD, PhD Physician
Associate Professor of Radiology Department of Surgery
Weill Medical College of Cornell University; Stony Brook University Medical Center
Assistant Attending Physician Stony Brook, New York
Department of Radiology
Memorial Sloan Kettering Cancer Center Itaru Endo, MD, PhD
New York, New York Professor and Chairman
Department of Gastroenterological Surgery
Safi Dokmak, MD Yokohama City University Graduate School of Medicine
Physician Yokohama, Japan
Hepatobiliary Surgery and Liver Transplantation Unit
Beaujon Hospital C. Kristian Enestvedt, MD, FACS
Clichy, France Assistant Professor of Surgery
Division of Abdominal Organ Transplantation/Hepatobiliary
Marcello Donati, MD, PhD Surgery
Assistant Professor of Surgery Oregon Health & Science University
General and Oncologic Surgery Unit Portland, Oregon
Department of Surgery and Medical-Surgical Specialties
University of Catania N. Joseph Espat, MD, FACS
Catania, Italy Professor of Surgery
Department of Surgery
M. B. Majella Doyle, MD, FACS Roger Williams Medical Center
Director, Liver Transplant Boston University School of Medicine
Director, Transplant HPB Fellowship Program Providence, Rhode Island
Section of Abdominal Transplantation
Washington University School of Medicine Cecilia G. Ethun, MD
St. Louis, Missouri Research Fellow
Division of Surgical Oncology
Vikas Dudeja, MBBS Department of Surgery
Assistant Professor Winship Cancer Institute of Emory University
Department of Surgical Oncology Atlanta, Georgia
Miller School of Medicine
University of Miami Sheung Tat Fan, MD, PhD, DSc
Miami, Florida Director
Liver Surgery Centre
Mark Dunphy, DO Hong Kong Sanatorium and Hospital;
Assistant Attending Physician Honorary Clinical Professor of Surgery
Department of Radiology Department of Surgery
Memorial Sloan Kettering Cancer Center The University of Hong Kong
New York, New York Hong Kong, China
Truman M. Earl, MD Paul T. Fanta, MD
Associate Professor Associate Clinical Professor
Department of Surgery Division of Hematology and Oncology
Division of Transplant and Hepatobiliary Surgery Department of Medicine
University of Mississippi Medical Center University of California, San Diego
Jackson, Mississippi San Diego, California
Tomoki Ebata, MD Olivier Farges, MD, PhD
Associate Professor Department of Hepato-Pancreatic-Biliary Surgery and Liver
Division of Surgical Oncology Transplantation
Department of Surgery Beaujon Hospital
Nagoya University Graduate School of Medicine Clichy, France
Nagoya, Japan
