Long-term survival following extended hepatectomy with concomitant resection of all major hepatic veins for intrahepatic cholangiocarcinoma: report of a case.

[cholangiocarcinoma]

Intrahepatic cholangiocarcinoma involving all major hepatic veins was diagnosed in a 62 -year -old man . Multidetector-row computed tomography showed a massive tumor occupying segments 2 -5 , 7 , and 8 , with invasion of all major hepatic veins , although the inferior right hepatic vein , draining the venous flow of segment 6 , was clearly visualized . Therefore , we planned an extended left trisectionectomy , involving resection of segments 1 -5 , 7 , and 8 , with extrahepatic bile duct resection and concomitant resection of all major hepatic veins . We performed portal vein embolization of the right anterior portal branch and the portal branch of segment 7 to identify the demarcation between segments 6 and 7 on the surface of the right lobe . We were able to divide the hepatic parenchyma between segments 6 and 7 and the planned surgery was accomplished , with repositioning of the confluence of the inferior right hepatic vein to prevent outflow blockage . The histological findings were pT 3 N 0 M 0 , Grade 2 , Stage III , and R 0 resection , according to the UICC classification (seventh edition ). Although remnant liver metastases were detected 75 Â months after surgery , the patient is still alive and being treated with chemotherapy , 88 Â months after surgery . We report this case to demonstrate how using portal vein embolization to identify the hepatic segment helps accomplish extended hepatectomy preserving only one segment and that R 0 resection by extended hepatectomy with concomitant resection of all hepatic veins can achieve a satisfactory outcome .

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cholangiocarcinoma

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