Central hepatic bisectionectomy with hepatic artery and biliary tracts reconstruction for the patient with nodular type intrahepatic hilar cholangiocarcinoma: A case report. (May 2021)

• Record Type: Journal Article
• Authors: Umemura, Akira; Nitta, Hiroyuki; Takahara, Takeshi; Hasegawa, Yasushi; Sugai, Tamotsu; Sasaki, Akira
• Is Part Of: International journal of surgery case reports. Volume 82(2021)
• Publication Date: 2021-05
• Subjects: Central bisectionectomy -- Cholangiocarcinoma -- Major liver resection -- Hepatic artery reconstruction -- Biliary tract reconstruction; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2021.105868
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: A central hepatic bisectionectomy (CHBS) for malignant hepatic tumors is a challenging procedure due to surgical difficulty. We describe radical CHBS with hepatic artery and biliary tracts reconstruction for a patient with cholangiocarcinoma (CCA). We reconstructed the anastomosis of the hepatic artery and then performed choledochojejunostoies. Aggressive liver resection for hilar CCA could achieve similar long-term survival rates. Abstract: Introduction and importance: A central hepatic bisectionectomy (CHBS) for a hilar cholangiocarcinoma (CCA) is technically challenging because bilateral biliary reconstruction is required after resection. On the other hand, hepatic artery resection and reconstruction in a major liver resection are also technical procedures. In this report, we describe our radical CHBS with hepatic artery and biliary tracts reconstruction for a patient with nodular type intrahepatic hilar CCA. Case presentation: A 76-year-old man was referred for further investigation of an incidental hepatic tumor. The hepatic tumor was located from medial sector to anterior sector with encasement of the anterior branch of the right hepatic artery. Based on these findings, we performed a CHBS with right hepatic artery and biliary tracts reconstruction. The histopathological findings revealed that the tumor consisted of moderately differentiated tubular adenocarcinoma with tumor necrosis without a fibrous capsule. In this area, tumors cells had invaded branches of the hepatic vein; however, there was no destructive invasion to the hepatic artery. Consequently, he was diagnosed with a nodular type intrahepatic hilar CCA with pT2aN0M0. Clinical discussion: A CHBS is usually performed with the intent of anatomically preserving a patient's liver as much as possible. Concomitant resection and reconstruction of the hilar vessels and biliary tracts with CHBS is one of the most technically challenging procedures in liver resections. Conclusion: A CHBS with hepatic artery and biliary reconstruction may be a promising alternative if expert surgeons perform it on strictly selected patients.