Selective hypertrophy of the lobus caudatus as a novel approach enabling extended right hepatectomy in the presence of a non-perfused left lateral liver lobe.

[cholangiocarcinoma]

Portal vein embolization (PVE ) is a well-established technique to enhance functional hepatic reserves of segments II and III before curative extended right hepatectomy for tumors of the right liver lobe . However , an adequate hepatopetal flow of the left lateral portal vein branches is required for a sufficient PVE-associated hypertrophy .Here , we report a 65 -year old patient suffering from a locally advanced intrahepatic cholangiocarcinoma in the right liver lobe and segment IV . A curative extended right hepatectomy after preoperative PVE of liver segments IV-VIII was initially impossible because of partial thrombosis of the left lateral portal vein branches resulting in an ischemic-type atrophy of segments II and III . However , due to a massive hypertrophy of the caudate lobe following PVE of liver segments IV-VIII , subsequent extended right hepatectomy with intraoperative thrombectomy of segments II and III was made possible .To our knowledge this is the first case in which an extended right hepatectomy for a liver malignancy , in the presence of atrophic left lateral section , was made possible by a massive PVE-associated hypertrophy of the caudate lobe .