Abstract
BackgroundBile duct tumor thrombus (BDTT) is one of the features of advanced hepatocellular carcinoma (HCC). In the resection of HCC with BDTT, it is important to detect the BDTT tip to decide the appropriate point of bile duct division. In this regard, the efficacy of indocyanine green (ICG) fluorescence navigation has been confirmed for the detection of HCC, whereas its utility for BDTT has not yet been reported. Herein, we describe our experience with right hepatectomy for HCC with BDTT using ICG fluorescence navigation.Case presentationA 72-year-old woman had experienced local recurrences of HCC after radiofrequency ablation, with BDTT reaching the confluence of the right anterior branch and posterior branch. Right hepatectomy was planned, and 2.5 mg of ICG was injected one day before surgery. After transection of the liver parenchyma, the right liver was connected with only the right hepatic duct. ICG fluorescence imaging visualized the tip of BDTT in the bile duct with clear contrast; the proximal side (hepatic side) of the right hepatic duct showed stronger fluorescence than the distal side (duodenal side). The bile duct was divided at the distal side of the BDTT border, and the tip of BDTT was recognized into the resected right hepatic duct without laceration. The patient had an uneventful postoperative course and currently lives without recurrences for 6 months.ConclusionsICG fluorescence navigation assisted in the precise resection of the bile duct in HCC with BDTT.
Highlights
Bile duct tumor thrombus (BDTT) is one of the features of advanced hepatocellular carcinoma (HCC)
indocyanine green (ICG) fluorescence navigation assisted in the precise resection of the bile duct in HCC with BDTT
For the resection of HCC with BDTT localized primarily within the first branch of the bile duct, which is defined as B3 by the liver cancer study of Japan [12], it is important to detect the BDTT tip to decide about the appropriate point of bile duct division
Summary
Bile duct tumor thrombus (BDTT) is one of the features of advanced hepatocellular carcinoma (HCC). For the resection of HCC with BDTT localized primarily within the first branch of the bile duct, which is defined as B3 by the liver cancer study of Japan [12], it is important to detect the BDTT tip to decide about the appropriate point of bile duct division. We made a diagnosis of local recurrences of HCC after RFA, with BDTT reaching at the confluence of the anterior branch and posterior branch, which is defined as B3 by the liver cancer study of Japan [12]. ICG fluorescence imaging demonstrated the light of emission from the bile duct and BDTT with clear contrast; the proximal side (hepatic side) of the right hepatic duct exhibited stronger fluorescence than the distal side (duodenal side), which was compatible with the findings of IOUS before liver transection (Fig. 3e, f ). She lives without recurrences for 9 months after surgery
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