Portal Vein Arterialization as a Salvage Procedure During Left Hepatic Trisectionectomy for Hilar Cholangiocarcinoma

Abstract

d h c r s urgical resection for hilar cholangiocarcinoma (HCCA) emains a challenge for surgeons aiming to maximize paients’ chances for longterm survival. Since 1984, it has een accepted that standard bile duct resection should be ombined with an additional major hepatic resection to btain improved oncological clearance and increase quanity and quality of survival. This aggressive approach was nitially criticized, but today a consensus exists that perorming such extended resections is the treatment of choice or HCCA.There is strong evidence of better survival when 0 resection is performed. The extended resections that nable a better oncological clearance have become achievble as a result of the major advances in surgical techniques nd preoperative and postoperative care, which have reuced morbidity and mortality after major liver resection. Recent studies suggest that portal vein resection with econstruction can increase the chance for cure in some atients with advanced HCCA who were previously hought to have inoperable disease. Because perineual invasion correlates with poorer outcomes, theoretically, esection of the hepatic artery with its nerve sheath will uarantee an even better oncological result. Arterial resecion and reconstruction can be technically problematic and ometimes unachievable, with very few cases reported in he literature. To overcome this, a recent study rom Japan by Kondo and colleagues has reported 10 cases f portal vein arterialization (PVA) after hepatic artery reection for biliary cancers, with some accompanied by mall hepatic resections. We report a case where PVA was used with good result as salvage technique during left hepatic trisectionectomy nd a second case where the same technique was used to