Ten-Year Survival Following Left Hepatic Trisectionectomy with Combined Hepatic Artery and Portal Vein Resection for Advanced Perihilar Cholangiocarcinoma
by Haitham Triki1, Marie Livin1,2*, Stylianos Tzedakis3,4, Solène Florence Kammerer-Jacquet5, Laurent Sulpice1,2, Heithem Jeddou1,2, Karim Boudjema1,2
1Department of Hepatobiliary and Digestive Surgery, Pontchaillou University Hospital, Rennes, France
2University of Rennes 1, Rennes, France
3Department of Hepatobiliary, Digestive and Endocrine Surgery, University of Paris Cité, AP-HP, Cochin hospital, Paris, France
4University Paris Descartes, 75005 Paris, France
5Department of Pathology, University Hospital Pontchaillou, Rennes 1 University, Rennes, France.
*Corresponding author: Marie Livin, Department of Hepatobiliary and Digestive Surgery, University Hospital Pontchaillou, Rennes 1 University, Rennes, France
Received Date: 06 September, 2023
Accepted Date: 12 September, 2023
Published Date: 14 September, 2023
Citation: Triki H, Livin M, Tzedakis S, Kammerer-Jacquet SF, Sulpice L, et al. (2023) Ten-Year Survival Following Left Hepatic Trisectionectomy with Combined Hepatic Artery and Portal Vein Resection for Advanced Perihilar Cholangiocarcinoma. J Surg 8: 1885 https://doi.org/10.29011/2575-9760.001885.
Background: The main goal of surgery for perihilar cholangiocarcinoma is to achieve complete resection. Due to the intimate anatomical relationship between the biliary confluence and the vascular inflow at the hepatic hilum, the tumor can rapidly invade the portal vein and/or the hepatic artery. In patients with advanced disease, extended hepatectomies with vascular resection and reconstruction are required to reach tumor-free margins. In expert centers, this surgery can be performed with acceptable morbidity and mortality.
Case summary: We report the case of a 65-year-old woman presenting a perihilar cholangiocarcinoma classified as Bismuth IV involving the left and the right hepatic arteries, the portal vein bifurcation and the left portal branch (resulting in total left hepatic atrophy). After a percutaneous transhepatic biliary drainage of the right posterior liver, the patient had a left trisectionectomy, caudate lobectomy, resection of the main bile duct with simultaneous resection and reconstruction of the portal vein and the right hepatic artery. A biliary reconstruction using the Roux-en-Y jejunum limb over two separate segmental bile ducts was performed. Postoperative outcomes were mainly marked by the occurrence of bilioma. Histological examination showed a moderately differentiated biliary adenocarcinoma classified as pT2aN0M0. All margins were negative. The patient received 12 cycles of adjuvant gemcitabine-oxaliplatin. She is now healthy with no sign of recurrence 10 years after surgery.
Conclusion: Extended hepatectomy with vascular resection is the only way to obtain free tumor margin and to prolong survival.
Keywords: Case report; Extended hepatectomy; Perihilar cholangiocarcinoma; Vascular resection