Ann Liver Transplant.  2022 May;2(1):78-85. 10.52604/alt.22.0006.

Right trisectionectomy with en bloc portal vein resection for perihilar cholangiocarcinoma after preoperative left portal vein stenting and sequential right portal and hepatic vein embolization

• Hwang S
• Ko GY

• KMID: 2560885
• DOI: http://doi.org/10.52604/alt.22.0006

Abstract

We present a case report of successful right trisectionectomy with en bloc portal vein (PV) resection for perihilar cholangiocarcinoma after endovascular stenting of the PV combined with sequential embolization of the right PV and hepatic vein. The case was a 74-year-old female patient with Bismuth-Corlette type IV perihilar cholangiocarcinoma with invasion of the left PV, right anterior PV, and right hepatic artery. Preoperative right portal vein embolization (PVE) was considered for future remnant liver regeneration. During right PVE, a wall stent was inserted to restore the left portal blood flow. One week later, right hepatic vein embolization was sequentially performed. At four weeks after PVE, right trisectionectomy with caudate lobectomy, bile duct resection, PV segmental resection with removal of endovascular stent and end-to-end anastomosis, and Roux-en-Y hepaticojejunostomy were uneventfully performed. The PV was segmentally resected with inclusion of a wall stent. PV defect was repaired through end-to-end anastomosis. Pathology report showed that all resection margins were tumor-negative. The patient recovered uneventfully. She has been doing well for one year with no evidence of tumor recurrence. Preoperative PV stenting might have benefited the patient because it enabled us to perform major hepatectomy successfully. Our experience could help surgical planning for hepatobiliary malignancy patients with PV invasion.

Keyword

Right trisectionectomy; Perihilar cholangiocarcinoma; Endovascular stent; Portal vein embolization; Hepatic vein embolization