Abstract
The operative procedure for perihilar cholangiocarcinoma (PHC) should be selected not only by the longitudinal tumor extension to the bile duct and tumor invasion to the major hilar vessels, but also functional reserve of the future remnant liver. Right trisectionectomy (RTS) is the most extended resection among the standard resectional procedures (RTS, right hemihepatectomy, left trisectionectomy (LTS) and left hemihepatectomy). Despite the recent advance in surgical techniques and perioperative patient care, RTS is still considered to be associated with high mortality due to hepatic failure. Meanwhile, LTS is recently performed more frequently in patients with Bismuth type IV tumors of left side predominance in a specialized center. LTS can produce a longer resection margin for the right posterior sectional bile duct. However, LTH may be technically demanding with association to the high postoperative morbidity. Both hepatic trisectionectomy for PHC may be highly skillful and difficult procedures among the hepatobiliary surgeries. For successful surgery, careful evaluation of 3D hilar anatomy and also the functional reserve of future remnant are crucial. Herein, clinical significance of RTS and LTS for PHC is discussed, as well as the important 3D anatomical variations for these procedures.
