A vascular variant allows to resect "en bloc" cholangiocarcinoma Bismuth IV

Abstract

Background: Curative hepatectomy with bile duct resection is the treatment for perihilar cholangiocarcinoma. When vessel involvement in imaging preoperative studies is found, the use of more aggressive aproach with bloc resection is the recommendation. Methods: A video of the surgical approach used in a case of Bismuth type IV Klatskin tumor resected with extended left hepatectomy. Results: A 67-year-old man who presented with epigastric pain and abnormal liver function was referred to our clinic for further examination. Serial examination resulted in diagnosis of Bismuth IV hilar cholangiocarcinoma, atrophying mainly the left hepatic lobe, and infiltrating right and left hepatic artery branches. Fortunately, the patient presented a SVI-VII artery arising from gastroduodenal artery no invaded, anatomical variant that allows tumor resection, keeping the arterial supply of the liver. The variant anatomical of the vessel was identified preoperatively. He underwent left hepatectomy with the main right hepatic artery, caudate lobectomy and extrahepatic bile duct resection without any complications. Pathological study of specimen showed a 4.9x1.2cms cholangiocarcinoma with free margins. No recurrence 1 year late. Conclusion: Aggressive approach with "en bloc" and extended liver resections in the treatment of Bismuth IV hilar cholangiocarcinoma could be feasible. It’s important a meticulous preoperative evaluation with images in this cases, because we can identify anatomical variations make surgery possible.