Percutaneous microwave ablation liver partition and portal vein embolization for planned hepatectomy (PAPEP) for hilar cholangiocarcinoma

Abstract

Objective To evaluatge percutaneous microwave ablation liver partition and portal vein embolization for planned hepatectomy (PAPEP) in treatment of hilar cholangiocarcinoma with insufficient future liver remnant. Methods The clinical data of an advanced hilar cholangiocarcinoma case with small FLR treated by PAPEP was retrospective analyzed. Preoperative assessment showed a type Ⅳ (Bismuth) and staged Ⅳa (AJCC) carcinoma patient with right hepatic artery and right portal vein branch involvement. T-bil level decreased after PTCD, B ultrasound guided percutaneous microwave ablation liver partition (PMA) was performed, portal vein embolization (PVE) was done 1 day after PMA. Results The FLR increased by 37.55% to 527.44 ml 13 days after PMA+ PVE. A right trisegmentectomy combined with caudate lobectomy was performed, left portal vein was resected and reconstructed. Postoperative subphrenic abscess and upper gastrointestinal bleeding caused by duodenal ulcer was successfully managed. No recurrence was found during 7 months follow-up. Conclusions PAPEP is effective for the radical resection of advanced hilar cholangiocarcinoma with insufficient future liver remnant. Key words: Bile duct neoplasms; Hepatectomy; Future liver remnant; ALPPS