Abstract
Since portal vein embolization has been incorporated in the standard preoperative patient's care, hemihepatectomy or more extended hepatectomy is considered as a first-line surgical approach for perihilar cholangiocarcinoma. In present, various type of hepatectomy performed has been organized in four procedures: left hepatectomy, left trisectionectomy, right hepatectomy, and right trisectionectomy, with routine caudate lobectomy. Each hepatectomy has a specific line of resection of the intrahepatic bile duct, exclusively depending on the topological relationship between the biliary duct and portal vein. Therefore, the current radiologic diagnosis has focused on the main tumor location (Bismuth type), and presence or absence of the involvement at the estimated ductal stump in each hepatectomy; thereby, the suitable procedure among the four is scheduled. Herein, the intraoperative resection line of the duct is displayed graphically, and selection of the surgical procedure is outlined, according to Bismuth classification. Because candidates for definitive surgery require biliary drainage only in the future liver remnant, even non-surgeons should comprehend the characteristics of each hepatectomy.
