Portal vein resection and reconstruction using autologous external iliac graft interposition for advanced perihilar biliary malignancies

Abstract

The bile ducts are anatomically located in close proximity to the hepatic artery and portal vein, and advanced biliary tract cancers are likely to involve these hepatic inflow vessels. In perihilar cholangiocarcinoma surgery combined with portal vein resection, forms of resection and reconstruction of the portal vein varies depending on the extent and location of the portal vein involvement. In most of cases, segmental resection followed by direct end-to-end anastomosis is applied; however, in cases where direct anastomosis is unfeasible, reconstruction utilizing grafts is considered. Autologous venous grafts are typically employed, with the external iliac vein being the preferred choice due to its optimal characteristics. The paper focuses on the technical aspects of portal vein interpositional graft reconstruction for perihilar cholangiocarcinoma.