2021 Volume 35 Issue 4 Pages 636-642
The subject was a 68-year-old female. Upon close examination, she was diagnosed with left-dominant Bismuth IV hilar cholangiocarcinoma. The left lobe had contracted due to occlusion of the portal left branch, while the anterior segmental branch of the right hepatic artery system was diagnosed as positive for segmental plexus infiltration. Although we considered resection of the left lobe and caudate lobe based on the estimated residual liver volume, because it requires combined resection of the anterior segment arterial branch, technical difficulties during reconstruction and potential ischemia in the anterior segment without performing reconstruction were a concern. We carried out coil embolization of the infiltration-positive site with a length of approximately 2cm at the anterior segment arterial branch prior to surgery. Resection of the hepatic left lobe and caudate lobe, resection of the extrahepatic bile duct, combined resection of the portal vein and reconstruction, and combined resection of the anterior segmental branch of the right hepatic artery were performed. A pathological diagnosis revealed pT2bN0, pStage II, and R0. Although anastomotic leakage occurred following surgery, she improved with conservative treatment. She has been followed up as an outpatient for 4 years and 5 months without recurrence. Following coil embolization of the anterior segment arterial branch prior to surgery for development of the intrahepatic collateral flow, we carried out left hepatectomy along with resection of the anterior segment arterial branch without reconstruction, resulting in a safe R0 resection.
