Left trisectionectomy plus caudate lobectomy (S1) and resection of biliary duct for Bismuth type IV peri-hilar cholangiocarcinoma

Abstract

Background: Extended left hemihepatectomy or left trisectionectomy is a challenging procedure that can be applied in patients affected peri-hilar cholangiocarcinoma involvng right second order bile ducts. This procedure requires an extensive preoperative evaluation with future liver volume calculation and liver function assessment. Methods: A 68-years-old male with a peri-hilar cholangiocarcinoma (Bismuth type IV) with jaundice (pre-operational bilirubin 6.8 mg/dL). Future remnant liver volume for S6-7 was 35%A left trisectionectomy plus S1 and common bile duct resection was planned without preoperative biliary drainage. Results: The video shows the surgical technique including en bloc lymphadenectomy, left trisectionectomy with en bloc S1 resection and common bile duct resection. The reconstruction was performed with single bilio-enteric anastomosis of right posterior bile duct. Postoperative course was eventful and patient was discharged in 10th postoperative day. Pathology report confirmed the R0 resection with negative lymph-nodes (0/24). Conclusion: An extended resection with a locoregional lymphadenectomy is the potentially curative option for patients with a peri-hilar Bismuth type IV colangiocarcinoma.